The top up

1. 20ml 0.5% bupivacaine

Increments of 5ml to effect

Opioids: either fentanyl or diamorphine

Generally there are three options:

  1. (Levo)bupivacaine 0.5% + opioid

  2. 'Fizzy' Lignocaine 2% + opioid

  3. Take out epidural and do a spinal

2. In a 20ml syringe:

2ml 8.4% sodium bicarbonate

0.1ml (100mcg) adrenaline

make up to 20ml with

2% lignocaine 

Increments of 5ml to effect

Opioids: either fentanyl or diamorphine

3. Spinal.

Consider if epidural has been inadequate, or not in situ long enough to be tested or previously loaded.

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