The extension of epidural blockade for emergency caesarean section: a survey of Scandinavian practice

• The practice of epidural top-up for emergency caesarean section in Scandinavia was investigated.
• Epidural top-ups were initiated in the labour ward by 33% of specialists.
• 25 different drug combinations were reported for epidural top-ups.
• 80% of specialist recommended their own practice to trainees.

BackgroundLittle is known about drugs and safety precautions used during epidural top-ups for emergency caesarean section in Scandinavia. We surveyed Scandinavian practice of epidural top-up regimens for emergency caesarean sections.MethodsAnaesthetic departments in Denmark, Norway and Sweden were identified via National Boards of Health. An electronic questionnaire was sent to Scandinavian specialist anaesthesiologists performing obstetric anaesthesia asking for information on anaesthetic practice for emergency caesarean section.ResultsThe response rate was 80% (n=145). One hundred and twenty (83%) specialists reported the existence of local guidelines for epidural top-ups. Fourteen (9.7%) specialists gave a full-dose top-up in the delivery room, 34 (23.4%) initiated the top-up with a test-dose, and 87 (60%) only administered local anaesthetics in the operating theatre. Twenty-five different drug combinations for epidural top-ups were reported. Lidocaine was used by 67 (47.9%) and ropivacaine was used by 53 (37.9%). Seventy (50%) specialists added opioid to the top-up, 15 (10.7%) added bicarbonate and 53 (37.9%) supplemented with adrenaline. Median top-up volume ranged from 16 to 19 mL for lidocaine, ropivacaine and chloroprocaine. One-hundred-and-eighteen (81%) specialists recommended trainees use the same regimen. Forty (83%) of 48 specialists topping-up in the labour unit had ephedrine readily available. During transport, pulse oximetry was used by nine (19%) and non-invasive blood pressure monitoring by eight (17%).ConclusionsEpidural top-ups for emergency caesarean section in Scandinavia are used frequently but normally performed in the operating theatre. Drugs used differ greatly between countries and departments although top-up volumes appear similar. During transport, available equipment and drugs were limited. Best practice guidelines and national guidelines present little information on epidural top-ups that could explain the variation found.