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Epidural Top-Up for Emergency Surgery — FRCA Final MCQ

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ModerateObstetric AnaesthesiaEpidural Top-Up for Emergency SurgeryFRCA Final

A 40-year-old woman (ASA II, 70 kg) at 36 weeks gestation requires urgent appendicectomy. She has a functioning labour epidural in situ (currently off). Her platelet count is 142 × 10⁹/L and coagulation is normal. Can the existing epidural be used for surgical anaesthesia?

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Correct answer: A — General anaesthesia is the only option

A functioning epidural catheter already in situ can be topped up to provide surgical anaesthesia for emergency/urgent abdominal surgery. This avoids the risks of GA (airway, aspiration) and a new neuraxial procedure. The top-up typically uses 15-20 mL of 2% lidocaine with adrenaline 1:200000 (fastest onset) or 0.5% bupivacaine (slower onset, longer duration), aiming for a T4 bilateral block. Before top-up: aspirate the catheter (check for blood/CSF), give a test dose, and administer incrementally with monitoring. This is a standard obstetric anaesthetic practice.

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