Many conversions to general anaesthesia follow an inadequate block that was not tested properly. Before incision, test the block bilaterally to cold or light touch and record the level, aiming for a block to touch at about T5 or higher on both sides. Check sacral dermatomes too, since sacral sparing causes pain during delivery and closure.
For a labour epidural being extended, give the top-up early and in the delivery room or theatre with full monitoring, and do not start surgery on time pressure alone if the block is clearly inadequate and time allows. Supplement with intravenous analgesia only for mild discomfort; if pain is severe, convert to general anaesthesia rather than escalating sedation in an unprotected airway.
- Test the block bilaterally and record the level before incision.
- Aim for a block to touch at around T5 or higher on both sides.
- Check sacral dermatomes for sparing.
- Top up labour epidurals early when a Caesarean becomes likely.
- Convert to general anaesthesia rather than deepen sedation for severe pain.
Why it matters
A documented test is the simplest defence against intraoperative pain and unplanned general anaesthesia.
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