She’s somewhere between five and six centimeters.”
“Perfect,” Jeffrey said. He was pleased. “I’ll be right over.”
En route to the delivery area, Jeffrey stopped at the anesthesia office to glance at the big board to see about the evening assignments. As he expected, everyone was busy with ongoing cases. He took a piece of chalk and wrote that whenever someone was free he or she should come over to delivery and relieve him.
When Jeffrey arrived in labor room fifteen, Patty was in the middle of a contraction. An experienced LPN was with her and the two women were functioning like a practiced team. Beads of sweat dotted Patty’s brow. Her eyes were shut tightly, and she was gripping the nurse’s hands with both of hers. Strapped to her abdomen was the rubber monitor keeping track of the progress of the labor as well as the fetal heartbeat.
“Ah, my white knight in blue,” Patty said as the pain abated and she opened her eyes to see Jeffrey standing at the foot of the bed. She smiled.
“How about that epidural?” Jeffrey suggested.
“How about it!” Patty echoed.
All the equipment Jeffrey needed was on a cart he had wheeled in with him upon his return. After putting a blood pressure cuff in place, Jeffrey removed the rubber monitor from Patty’s abdomen and helped position her on her side. With gloved hands he prepped her back with an antiseptic solution.
“First I’m going to give you the local anesthetic we talked about,” Jeffrey said as he prepared the injection. He made a small weal with the tiny needle midline in Patty’s lower back. She was so relieved to be getting it, she didn’t even flinch.
Next, he took a Touhey needle from the epidural tray and made sure the stylet was in place. Then, using both hands, he pushed the needle into Patty’s back, advancing it slowly but de liberately until he was certain he had reached the ligamentous covering of the spinal canal. Withdrawing the stylet, he attached
I an empty glass syringe. Jeffrey put slight pressure on the sy ringe’s plunger. Feeling resistance, he expertly returned to ad vancing the needle. Suddenly the resistance on the plunger disappeared. Jeffrey was pleased: he knew he was in the epidural space.
“Are you okay?” Jeffrey asked as he used a glass syringe to draw up a test dose of 2 cc’s of sterile water containing a tiny amount of epinephrine.
“Are you flnished?” Patty asked.
“Not quite,” Jeffrey said. “Just a few minutes more.” He injected the test dose and immediately tested Patty’s blood pressure and pulse. There was no change. If the needle had been in a blood vessel, Patty’s heart rate would have increased immediately in response to the epinephrine.
Only then did Jeffrey seize the small epidural catheter. With practiced care, he threaded it up the Touhey needle.
“I feel something funny in my leg,” Patty said nervously.
Jeffrey stopped pushing the catheter. It was only in about one centimeter beyond the tip of the needle. He asked Patty about the sensation, then explained that it was common for the epidural catheter to touch peripheral nerves as they traversed the epidural space. That could account for what she was feeling. When the paresthesia subsided, Jeffrey gingerly advanced the catheter another one and a half centimeters. Patty didn’t complain.
Finally, Jeffrey pulled the Touhey needle out, leaving the small plastic catheter in place. Then he prepared a second test
dose of 2 cc’s of.25% spinal-grade Marcaine with epinephrine. After injecting this second dose, he monitored Patty’s blood pressure and her sense of touch on her lower extremities. When there were no changes even after several minutes, Jeffrey was absolutely sure that his catheter was in the proper place. Finally, he injected the therapeutic dose of anesthetic:
5 cc’s of.25% Marcaine. Then he capped off the catheter.
“That’s all there is to that,” Jeffrey said as he put a sterile bandage over the puncture site. “But I want you to stay on your side for a while.”
“But I don’t feel anything,” Patty complained.
“That’s the idea,” Jeffrey said with a smile.
“You’re sure it’s working?”
“Just wait until your next contraction,” Jeffrey said with confidence.