Author(s): Davies MW, Harrison JC, Ryan TD
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Abstract A postal survey of all maternity units in the United Kingdom was conducted to gain information regarding policies for epidural analgesia for labour. The average epidural rate was 19.7\% and 78\% of units offered a 24-h service. The majority of units inserted the epidural with the patient in the lateral position, using a midline approach, with loss of resistance to air and saline being used almost equally. Most units used 3 ml of 0.5\% bupivacaine as a test dose, and only 10\% of units used adrenaline in the test dose. The use of adrenaline in subsequent top-ups was infrequent. Bupivacaine 0.5\% was used most frequently for the initial and the second stage top-up, whereas 0.25\% was most often used during the first stage of labour. Midwife top-ups were allowed in 75\% of units and in only 14\% of cases was this from a local anaesthetic reservoir. Epidural analgesia using a continuous infusion of anaesthetic was routinely used in 28\% of units, mostly with 0.125\% bupivacaine; about half of these units did so because midwives were unable to perform top-ups. Routine use of epidural opioids was most frequent when anaesthetic infusions were used, otherwise it was uncommon.
This article was published in Anaesthesia
and referenced in Journal of Anesthesia & Clinical Research