skip to main content

Existing Block for Emergency CS — FRCA Final MCQ

Instant feedback + full explanation. One question, done properly.

HardObstetric AnaesthesiaExisting Block for Emergency CSFRCA Final

A 35-year-old primigravida at 41 weeks has a prolonged second stage of labour. An epidural has been running for 12 hours. She is taken to theatre for a trial of forceps. The epidural is topped up with 15 mL 2% lidocaine with adrenaline. She develops a dense motor block to T4 but then becomes hypotensive (BP 70/40) despite left lateral tilt and phenylephrine boluses. CTG shows fetal bradycardia. The decision is made for category 1 caesarean section. With an already dense block to T4, what anaesthetic management is required?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: B — Proceed with surgery under the existing epidural block

With an adequate sensory block already established to T4 and a dense motor block from the recent 2% lidocaine top-up, there is no need for additional anaesthesia. The block is already at an appropriate level for caesarean section (target T4). The priority is haemodynamic management (phenylephrine/ephedrine, crystalloid bolus, left lateral tilt) rather than administering more local anaesthetic. Performing a spinal on top of a working high epidural risks total spinal. GA introduces unnecessary airway risks. Surgery should proceed immediately using the existing block.

Reference: OAA – 2024 – QRH: Epidural top-up assessment; RCOA GPAS – 2025 – Chapter 9