Epidural Rounding Note Generator

Patient / Case Information

Patient name

MRN / DOB

Location / unit

Date & time of round

Rounding provider

Day of epidural / POD#

Indication

Labor analgesia Postoperative analgesia Chronic pain management Other

Pain Assessment

Pain score at rest (0-10)

Pain score with movement/activity (0-10)

Adequacy of analgesia

Adequate Inadequate — breakthrough pain Excessive — motor block/oversedation

Sensory / Motor Exam

Sensory level (dermatome)

Block symmetry

Symmetric Asymmetric

Motor block (Bromage score)

0 — No block 1 — Just able to flex knees 2 — Unable to flex knees 3 — Complete block

Catheter / Site Check

Dressing intact Erythema/redness at site Leakage/wet dressing Tenderness at site Catheter depth unchanged from placement Catheter appears migrated/dislodged

Current catheter depth at skin (cm)

Site check notes

Infusion Details

Current infusion medication/concentration

Current rate (mL/hr)

Other scheduled analgesics administered

Other PRN analgesics administered

Side Effects

Side effect management / notes

Plan

Continue current regimen unchanged Increase infusion rate Decrease infusion rate Change medication/concentration Wean infusion Discontinue / remove catheter Consult acute pain service Notify anesthesia team of concern

Plan for other analgesics

Scheduled PCM and NSAID Gabapentin or pregabalin Morphine Additional adjuncts

Anticoagulation

Heparin Enoxaparin None Other

Hold prophylactic heparin 4-6 hours prior to removal Hold prophylactic enoxaparin 12 hours prior to removal

Plan detail / rationale

Anticipated timing for removal