Date of Award

Spring 5-5-2023

Document Type

DNP Project

Project Team Faculty Member

Dr. Rebecca Collier

Project Team Faculty Member

Dr. Jenna Tebbenkamp


Labor epidural, failed epidural, neuraxial anesthesia, obstetrics, epidural to cesarean section


In the United States, epidural anesthesia is used for approximately 29-44% of cesarean sections (Carvalho, 2012). A failed or inadequate labor epidural is challenging to manage, especially when a cesarean section is imminent. A failed labor epidural is defined as insufficient pain relief within 45 min after placement, accidental dural puncture, re-siting or abandoning the procedure, and patient dissatisfaction at follow-up (Ismail et al., 2021). This project examined established best practices for managing a parturient with an ineffective labor epidural that requires a cesarean section. The literature review provided zero practice guidelines for the management of failed epidural for cesarean section. Anesthesia providers usedifferent approaches to manage an ineffective epidural. If the epidural catheter adjustment or top-up dosing does not provide sufficient anesthetic conditions and time permits, replacing the epidural catheter or performing a spinal is safe, but the appropriate dose of LA must be considered based on the level of the current block (Bauer et al., 2012).

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Conceptual Framework

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