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Epidural top-up for caesarean section — FRCA Final MCQ

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EasyObstetric AnaesthesiaEpidural top-up for caesarean sectionFRCA Final

A woman with a functioning labour epidural requires emergency caesarean section for failure to progress with non-reassuring fetal trace. A top-up with lidocaine and fentanyl produces a bilateral T4 block, she is comfortable, and maternal observations are stable. What is the most appropriate anaesthetic technique?

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Correct answer: D — Proceed with epidural surgical anaesthesia and continuous assessment

A functioning labour epidural that achieves a bilateral T4 block can be used for caesarean section anaesthesia if the mother is comfortable and observations are stable. General anaesthesia is not required purely because surgery is urgent. A new spinal after a dense epidural top-up increases high-block risk. Continuous assessment remains essential because inadequate block should be recognised before incision and managed promptly.

Reference: OAA caesarean section anaesthesia guidance; RCoA GPAS obstetric standards