Maternal Analgesia Flashcards
(20 cards)
management options for analgesia in labour
- support
- doula
- systemic opiates
- inhalations
- regional neural conduction blockade
- TENS, hypnosis
what opiates can be given?
morphine or pethidine
dosages of morphine and pethidine
> Early Labor
Morphine 10 -15mg IMI or
Pethidine 75-100mg IMI
> Late Labour ( 2hrs to delivery )
Morphine 3-5mg slow IV or
Pethidine 25-50mg by slow IV injection
what can be given along with the opiates
anti-emetic drugs such as Prochlorperazine (Stemetil) or Ondansetron (Zofran)
considerations when giving opiates
can cross the placenta – cause neonatal depression, esp if cumulative
* risks of IU hypoxia or pre-term labour
mx for baby with signs of resp distress after opiates given?
Naloxone / Narcan IMI
face mask O2
30 mins obs after resus
inhalational analgesia
Entonox: 50% nitrous oxide and 50% oxygen
- Given via facemask with a demand valve
Takes 15-20 seconds to work effectively
Side-effects: dizziness
gold standard of pain mx in labour
epidural
when is epidural most beneficial
Trial of labour in a primi-gravida
Prolonged labour anticipated
Uncomplicated severe pre-eclampsia [in the absence of thrombocytopenia/ coagulopathy] – assists with analgesia and blood pressure control
Inco-ordinate uterine action
Manipulative or instrumental delivery likely e.g. mal-presentation, twin pregnancy
benefit of epidural in VBAC
doesn’t mask signs of uterine rupture
patient requirements before doing an epidural
Informed, written consent
No contra-indications
IV line in situ (large bore IV cannula + crystalloid infusion)
equipment for epidural
Resuscitation equipment & drugs
Equipment for aseptic technique
Epidural needle, cannula & drugs
+ staff
absolute contra-indications for an epidural
Patient refusal
Coagulopathy or thrombocytopenia
e.g. HELLP syndrome
Active or uncontrolled haemorrhage
e.g. abruption or placenta praevia
Local skin sepsis in lumbo-sacral region
Known allergy to local anaesthetic drugs
Inadequate resuscitation equipment
relative contraindications to an epidural
Advanced aortic or mitral stenosis
Thrombocytopenia
Active neurological disorders or spinal abnormalities
Eclampsia
common complications of epidural
Hypotension
Nausea and vomiting
Sedation
Shivering
Modest increase in body temperature
Motor weakness
serious rare complications of epidural
- dural puncture
- IV injection
- neuro damage
- epidural abscess
result of a dural puncture
Subarachnoid injection of local anaesthetic drug causing high or total spinal anaesthesia
Post-dural puncture headache
result of IV injection during epidural
Acute toxic overdose with neurologic and cardiac symptoms: convulsions, cardiac collapse
TENS mechanism
Commonly and successfully used as a drug-free, natural method forpain reliefduringlabor.
The small, hand-held machines use a mild and painless electrical current to relieve pain.
The women can operate theTENSunit themselves, by regulating the intensity of the impulses duringpainfulcontractions.
hypnosis mechanism
There are two options
(1) Use a hypnotherapist who stays with the mother during labour and helps to guide her into hypnosis
(2) Learn from a hypnotherapist or instructor during pregnancy how to use self-hypnosis.
This can be used to moderate labour pain - Researchers think that hypnotherapy works by altering the way the mothers perceive pain.
It is thought that using hypnosis alters the higher centers of their central nervous system so that entering into a state of self-hypnosis during labor may activate certain mental processes that make potentially painful sensations less unpleasant or even non-painful.
