Labor Analgesia Dose Cheat Sheet

Last updated: February 9, 2026

CSE IT Dose

bupivacaine 0.25% 1 mL + fentanyl 10 mcg. Consider omitting fentanyl for history of severe itching or concern for non-reassuring fetal heart rate. Consider omitting bupivacaine if need to avoid motor block or hypotension.

Loading Epidural

For moderate/severe pain: give test dose then bupivacaine 0.125% 10-15 mL or ropivacaine 0.2% 10 mL, and then also fentanyl 50-100 mcg.

For mild pain: give test dose then (0.0625% bupivacaine + fentanyl 2 mcg/mL) solution 10-15 mL.

Top-offs
Early 1^st stage:
If low sensory level, clinician bolus 10-15 mL. Consider increasing PIEB bolus volume and/or decrease frequency.
If adequate level, bupivacaine 0.125% 10 mL + fentanyl 100 mcg or clonidine 100 mcg.

Mid-late 1^st stage or 2^nd stage/severe:

• bupivacaine 0.125% 10-15 mL
• ropivacaine 0.2% 10 mL
• lidocaine 1.5-2% 5 mL
• bupivacaine 0.25% 5 mL
• Adjuvants to add with the above items: fentanyl 50-100 mcg, or clonidine 50-100 mcg