Guidelines for Response to Motor Block During Epidural Analgesia
evaluation and vigilant follow-up for resolution are important. Treatment within
8 hours of symptoms resulting from cord compression by hematoma or abscess is
generally associated with the best outcome.
patient should be evaluated and treatment decisions made in the context of
multiple factors including:
the motor block is significant and/or represents a sudden change:
aspiration is positive for CSF - Turn
the infusion off until the patient is able to bend the knees and lift legs off
the bed, then replace the catheter, or change the infusion to an appropriate
dose for an intrathecal infusion (generally start with bupivacaine 1mg/hr).
Replacing the epidural is recommended unless a difficult insertion is
aspiration is negative for CSF -
Resume the infusion at a lower rate or lower concentration when the patient is
able to bend the knees and lift legs off the bed.
Generally if the catheter is located in the lumbar region, a change to a
lower concentration bupivacaine (i.e., 0.0625%) should be considered.
the motor block has not resolved in 4 hours,
obtain a stat MRI to evaluate for intraspinal process.
a stat neurosurgical consult if the MRI indicates abscess or hematoma. Send the
infusion solution container to the lab for content analysis.
there is some leg weakness, but the patient is able to bend the knees,
consider turning the epidural infusion rate down by 20-30% and re-evaluate in 2
hours. If the motor block persists, turn the infusion off until the block is
resolved and follow the instructions listed in # 4 above.