Local Anesthetic Infiltration

A New Item in the Neuraxial Procedure Note

We have added a question to assess how much pain patients have when we infiltrate local anesthetic into the epidural/spinal procedure note. We will be looking to see if this can predict women having more pain and needing more pain relief in labor and after cesarean delivery based on this score. At this point, we have not made entering this pain score mandatory before one can close the procedure note. However, we will assess compliance going forward. These pain scores will allow us to leverage EPIC to help study patient responses and ultimately influence care. Thanks for your support.

Suggestion script to tell patients immediately prior to LA infiltration: “I/We are going to inject the local anesthetic that will numb the area where we are going to do the epidural/spinal”

How and what to infiltrate: 3 ml of 1.5% lidocaine with epinephrine (in the epidural tray) injected subdermal (wheal) and subcutaneously over 3 seconds

When to assess pain after LA infiltration: Immediately after the 3 ml of local anesthetic has been administered and the LA infiltration needle is withdrawn.

Suggested script to assess pain after LA infiltration: “I/We are just finished injecting the local anesthetic that will numb the area where we are going to do the epidural/spinal. How painful was it from a scale of 0-10, with 0=no pain and 10=worse pain imaginable.”