Elective LSCS (Combined Spinal Epidural)

Regional AnaesthesiaDuration1 hourUpdatedJun 2026ByGas Cookbook

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

NeuraxialCombined Spinal Epidural

0.5% bupivacaine + 8% glucose2.4 ml

fentanyl25 mcg

Start phenylephrine100mcg/ml, 20ml/hr once spinal is administered

2 ml bolus to clear deadspace
Target normotension

Monitoring

NIBP 1-2 min cycles initially
ECG

For reference only. Always check doses against the BNF and your local protocols, and adapt to the patient in front of you. Gas Cookbook is community-shared guidance, not medical advice; clinical responsibility stays with you.

Procedure

Combined Spinal Epidural

Pulse oximetry

Infusions

phenylephrineTitrate to effect

Antibiotics

Cefuroxime1.5g
Metronidazole500mg

Uterotonics (Check contraindications)

Carbetocin100mcg or Oxytocin5 IU
Once baby delivered + cord clamped

Analgesia

Diamorphine3mg, Epidural
Paracetamol1g
Diclofenac100mg, PR

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

Check for block recovery (Able to raise legs 4 hours post block)

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

Pre-op

Block

Intra-op

Additional (If Required)

Post-op

LSCS Key Stages

Additional Resources