Local / narcotic mix (light epidural)
The current anaesthetic trend is to use a 'local' / Narcotic (or opiate) medication mix for epidurals. This is often referred to as the 'gold standard' of epidural anaesthesia and means that both a local anaesthetic (such as bupivacaine or ropivacaine) and a narcotic (such as Fentanyl or Sufentanil) are used together in the same epidural.
The aim of combining these two types of drugs is to provide adequate pain relief for the labouring woman but reduce the amount of local anaesthetic she needs to achieve this. By reducing some of the 'local', then some of main side effects (such as low blood pressure and not being able to push the baby to be born) can also be reduced. This type of epidural usually also allows the woman to be more mobile and is sometimes referred to as a 'light epidural'.
In using both medications, the side effects of both are then possible, although the side effects of the 'local' medications are usually slightly less common and less severe with a mixed epidural. You can read these side effects in the previous 2 pages.
Intermittent and continuous epidurals
Apart from the different types of medications that can be used in an epidural, there are also different ways it can be administered. The 2 most common ways are intermittent and continuous epidurals.
An 'intermittent' epidural
A continuous epidural
An 'intermittent' epidural means that the medications are injected through the epidural catheter periodically (usually every 90 minutes to 2 1/2 hours) by the anaesthetist or midwife. These subsequent doses of medications are usually referred to as 'top-ups'. Intermittent epidurals were the original way they were administered and many are still given this way, depending on the anaesthetist and the hospital.
The woman usually dictates the timing of top-ups, when she starts to be aware of the pain returning.