Gas Cookbook | LSCS (Epidural Top-Up)

One / both arms out of gown (enables better skin to skin later)
3-way octopus to cannula (Fluid + Phenylephrine infusion + Spare port)

NeuraxialEpidural

Only if epidural working appropriately.

2% Lidocaine + 1:200,000 Adrenaline3ml test dose

Starting Dose

0.5% Bupivacaine15-20ml, increments of 5ml or 2% Lidocaine + 1:200,000 Adrenaline15-20ml
and
fentanyl50-100mcg, epidural

Monitoring

NIBP 1-2 min cycles initially
ECG
Pulse oximetry

Infusions

phenylephrineTitrate to effect

Antibiotics

Cefuroxime1.5g
Metronidazole500mg

Uterotonics (Check contraindications)

Carbetocin100mcg or Oxytocin5 IU
Once baby delivered + cord clamped

Analgesia

Anti-emetics

ondansetron4mg

Uterotonics

ergometrine500mcg, IM : Avoid in pre-eclampsia / hypertension
carboprost / Hemabate250mcg, IM : Avoid in asthma. Every 15 minutes up to 8 doses.
misoprostol4 x 200mcg, PR

Other

Tranexamic acid1g

Analgesia

Paracetamol1g, QDS
Ibuprofen400mg, TDS
Dihydrocodeine30mg, QDS
Dihydrocodeine30mg, QDS PRN
MorphinePO, PRN

Anti-emetic

Ondansetron4mg

Other

Laxative
LMWH 6 hours post-op
TEDS
Fluids

Follow-Up

Pfannenstiel / Joel-Cohen incision (transverse lower abdomen)
Dissection through skin, fascia, rectus sheath, rectus muscle, peritoneum -> to reveal uterus
Bladder retraction
Uterine incision
Fundal pressure from assistant
Delivery (+/- delayed cord clamping)
Placental delivery (controlled cord traction)
Closure of uterine cavity (2 layers), rectus sheath, skin

Labour Pains

Details

Specialty: Obstetrics
Author: Gas Cookbook
Procedure: Epidural
Updated: Jun 2026

Example plan written by a clinician, not medical advice. Check every dose against the BNF and your local protocols and adapt to the patient in front of you. You remain responsible for every clinical decision. Disclaimer

Pre-op

Epidural Top-Up

Intra-op

Additional (If Required)

Post-op

LSCS Key Stages

Additional Resources

Details

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