Analgesia in labour

Question 1

Analgesia in labour - non-pharmacological methods (5)

Answer 1

1. Presence of trusted companion reduces the need for analgesia
2. Breathing and relaxation techniques
3. Massage
4. Warm bath
5. Transcutaneous electrical nerve stimulation (TENS)

Question 2

Analgesia in labour - pharmacological methods (3)

Answer 2

1. Nitrous oxide
2. Narcotic agents (pethidine, meptazinol)
3. Epidural analgesia

Question 3

Epidural analgesia - advantages

Answer 3

1. Effective analgesia in labour
2. Reduced maternal catecholamine secretion (thought to benefit fetus)
3. Can be topped up for operative delivery/other complications (e.g. difficult perineal repair)
4. Can provide effective post-operative analgesia
5. Can be used to aid BP control in pre-eclampsia

Question 4

Epidural analgesia - risks

Answer 4

Less serious (5)

1. Failure to site, or a patchy/incomplete block
2. Hypotension from sympathetic blockade
3. Decreased mobility
4. Tenderness over insertion site (but no association with long-term backache)
5. Increased risk of operative delivery

More serious but rare (5)
1. Inadvertent dural puncture
2. Respiratory depression
Extremely rare complications -> neurological defects:
3. Epidural abscess
4. Epidural haematoma
5. Damage to individual nerves/spinal cord itself

Question 5

Epidural analgesia - contraindications

Answer 5

1. Septicaemia or infection at site of insertion
2. Coagulopathy or thrombocytopenia
3. Raised intracranial pressure
4. Haemorrhage + cardiovascular instability or hypovolaemia
5. Known allergy to amide (lignocaine type - ?) local anaesthetic solutions opioids

Question 6

Epidural analgesia - method

Answer 6

1. Wide bore IV access
2. Position woman either on side or sitting, with back curved
3. Suitable interspace (usually L3/4) identified and lignocaine 1% injected
4. Identify epidural space by loss of resistance technique. Thread catheter in, withdraw needle and fix catheter firmly to skin
5. Continuous CTG needed. Monitor BP every 5 min for 20 min