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Reproductive Medicine > Pain relief in Labour and Anaesthesia for obstetrics > Flashcards

Pain relief in Labour and Anaesthesia for obstetrics Flashcards

1
Q

What are the criteria for ideal pain relief in labour?

A
  • Provides good analgesia
  • Safe for baby and mother
  • Predictable and constant effects
  • Be reversible
  • Easy to administer
  • Under control of mother
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2
Q

What are non-pharmacologcal methods of pain relief in labour?

A
  • Breathing exercises
  • Aromatherapy
  • Warm baths
  • Acupuncture
  • Hypnotherapy
  • TENS machine
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3
Q

When is a TENS machine most useful in labour?

A

Early labour - loses effect as labour progresses

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4
Q

What pharmacological methods can be used in labour for pain relief?

A
  • Entonox gas
  • Strong opiates
  • Local anaesthesia
  • Epidural anaesthesia
  • Spinal anaesthesia
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5
Q

What is entonox?

A

50% nitrous oxide, 50% oxygen

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6
Q

What are the benefits of entonox?

A
  • Self-administered
  • Quick onset
  • Short half life
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7
Q

What are side effects of entonox?

A
  • Faint
  • Nausea
  • Vomiting
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8
Q

What opitates are used in labour?

A
  • Pethidine
  • Morphine
  • Remifentanyl PCA
  • Diamorphine
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9
Q

What are side effects to opiods?

A
  • Nausea + vomiting
  • Drowsiness
  • Resp depression - woman and noenate
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10
Q

What forms of local anaesthesia are most commonly used in labour?

A

Lignocaine

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11
Q

What are features of local anaesthetic toxicity?

A
  • Perioral tingling
  • Praesthesiae
  • Confusion
  • Drowsiness
  • Light-headedness
  • Seizures
  • Coma
  • Cardiac arrest
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12
Q

What is inolved in an epidural anaesthesia?

A

Injection of local anaesthesia and opiate medication into the epidural space

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13
Q

What are contraindications to epidural anaesthesia?

A
  • Thrombocytopenia
  • Coagulopathy
  • Raised ICP
  • Local sepsis
  • Septic chock
  • Allergy to local anaesthesia
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14
Q

What are advantages of epidural anaesthesia?

A
  • Effective analgesia
  • Can be adjusted if need be
  • Effective after delivery if repair of vaginal tears needed
  • Best for baby
  • Can prevent raised BP in pre-eclampsia
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15
Q

What are dcomplications of epidural anaesthesia?

A
  • Hypotension
  • Epidural haematoma/abscess
  • Respiratory depression
  • Neurological deficit
  • Dural puncture
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16
Q

What fibres are anaesthatised in an epidural nerve block?

A

T11-S5

17
Q

What are epidrual anaesthesias useful for managing?

A
  • Breech presentation
  • OP position
  • Multiple pregnancy
  • Preterm delivery
  • Pre-eclampsia
  • Forceps delivery
18
Q

Where are local anaesthesia and opiod medications injected for spinal anaesthesia?

A

Subarachnoid space

19
Q

What are advantages of spinal anaesthesia?

A
  • Dense, anaesthetic bilateral block
  • Can stay awake and maintain own airway
20
Q

What are disadvantages of spinal anaesthesia?

A
  • Causes hypotension
  • Need for urinary catheter
  • Risk dural puncture
  • Small risk of nerve damage
21
Q

Where is a pudendal nerve block injected?

A

1cm beyond a point just below and medial to the ischial spine on each side

22
Q

What are the main uses for a puedendal nerve block?

A

Instrumental delivery

23
Q

What are options for simple anaesthesia during pregnancy?

A
  • Paracetamol
  • Dihydrocodeine/Codeine
  • Aspirin
24
Q

When should you avoid aspirin in labour?

A

Increases bleeding risk

25
Q

Why should you not use ibuprofen in pregnancy?

A

Can cause:

  • Premature closure of DA
  • Foetal oliguria
  • Oligohydramnios
  • Risk of bleeding in foetus
26
Q

When does visceral labour pain occur?

A

First stage - due to progressive mechanical dilatation of the cervix, distention of lower uterine segment and contraction of the uterine muscles. Also attributed to myometrial and cervical ischaemia occuring during contractions

27
Q

Where do pain fibres which are involved in visceral pain from labour originate from?

A

T10-L1

28
Q

When does somatic labour pain occur?

A

Late first stage and second stage - due to stretching and distention of the pelvic floor, perineum and vagina due to descent of the foetus

29
Q

What spinal level is somatic labour pain transmitted to?

A
  • S2-S4 - via pudendal nerve and perineal branches of posterior cutaneous nerve of the thigh
  • L1-L2 - branches of ilioinguinal and genitofemoral nerve

Reproductive Medicine (43 decks)

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