In a healthy adult parturient receiving a low‑concentration bupivacaine (0.0625‑0.125 %) plus fentanyl (2‑2.5 µg mL⁻¹) walking labour epidural with a background infusion of 8‑10 mL h⁻¹ and patient‑controlled epidural analgesia (PCEA) boluses of 5 mL every 10‑15 minutes, what are the anaesthetic implications for the epidural catheter removal (exit procedure)?

Anaesthetic Implications for Epidural Catheter Removal After Walking Labour Epidural

The epidural catheter can be safely removed immediately after delivery without specific timing restrictions or additional monitoring beyond standard postpartum care, as no special anaesthetic precautions are required for removal of a properly functioning labour epidural catheter. 1

Pre-Removal Assessment

Before removing the epidural catheter, verify the following:

• Confirm normal coagulation status if the patient received anticoagulant medications during labour; standard removal timing guidelines apply (e.g., minimum 10-12 hours after prophylactic low-molecular-weight heparin) 1
• Document the sensory and motor block level at the time of removal to establish a baseline neurological examination 2
• Ensure haemodynamic stability with blood pressure within normal postpartum range, as hypotension during catheter use should have resolved by the time of removal 2

Removal Technique

The actual catheter removal requires minimal anaesthetic consideration:

• No specific anaesthetic monitoring is required during or after catheter removal beyond routine postpartum vital signs 2
• Remove the catheter with gentle, steady traction while the patient is in a comfortable position (sitting or lateral) 1
• Inspect the catheter tip to ensure it is intact; a broken catheter requires neurosurgical consultation 2

Post-Removal Monitoring

Standard postpartum care applies after epidural catheter removal:

• No additional cardiovascular or respiratory monitoring is needed beyond routine postpartum observations 2
• Document sensory and motor function within 1-2 hours post-removal to confirm resolution of neuraxial blockade 2
• Assess for any signs of epidural haematoma or abscess (severe back pain, progressive motor weakness, bowel/bladder dysfunction) during routine postpartum checks over the next 24-72 hours 2

Special Considerations for This Specific Regimen

Given the low-concentration bupivacaine (0.0625-0.125%) and fentanyl (2-2.5 µg/mL) used:

• Motor block should be minimal or absent at the time of catheter removal, as these ultra-low concentrations produce predominantly sensory blockade 1, 3
• Residual analgesia may persist for 1-2 hours after stopping the infusion due to the fentanyl component, but this does not affect removal timing 4
• The total bupivacaine dose administered (background 8-10 mL/h plus PCEA boluses) remains well below toxic thresholds even with prolonged labour, as systemic absorption is gradual and elimination is rapid 5

Common Pitfalls to Avoid

• Do not delay catheter removal waiting for complete resolution of sensory block; the catheter can be removed as soon as it is no longer needed for analgesia 1
• Do not perform additional neurological testing beyond standard motor and sensory assessment unless specific concerns arise 2
• Do not confuse intrathecal catheter management (which requires more intensive monitoring during use) with standard epidural catheter removal, which is straightforward 2

Documentation Requirements

• Record the time of catheter removal and the total duration of epidural use 1
• Document intact catheter tip and any resistance or complications during removal 2
• Note the patient's neurological status (motor strength, sensory level) at the time of removal 2