Obstetric analgesia (Complete) Flashcards
(15 cards)
What is the pain ladder in management of obstetric pain?
1) Non-pharmacological methods:
- Exercise
- Heat therapy
- TEN stimulation
- Massage
- Accupuncture
- Hypnosis
2) Nitric oxide (first-line in vaginal delivery) [e.g. Entonox]
3) Simple analgesia (e.g. paracetamol)
4) Opiate analgesia (short-term use only)
- Oral codeine
- IV/IM diamorphine
5) Regional anaesthesia
- Epidural block
- Spinal block
6) Pudendal nerve block
What simple analgesia can be offered in pregnant patients?
Paracetamol
Why are NSAIDs such as ibuprofen contraindicted in pregnancy?
In early pregnancy: Increases risk of miscarriage
In late pregnancy: Increases premature closure of ductus arteriosus and oligohydraminos
When may opiods be considered in management of pain in pregnancy?
If pain is severe and acute, warranting short-term use
Give 2 examples of opiods which can be used in short-term management of pain
Oral codeine phosphate
IM/IV diamorphine
What is the first-line strong opiod analgesia in latent first stage labour?
IM Diamorphine
Has rapid duration of onset (20-40 mins) and lasts 2-4 hours
Why is long-term use of opiods not reccomended?
Due to increase risk of neonatal abstinence syndrome
What medications are contraindicted in pregnancy?
Aspirin (unless low-dose for pre-eclampsia)
NSAIDs
Strong opiods (esp if long-term)
Gabapentin or pregabalin
What pain management is offered first-line for vaginal deliveries?
Nitric oxide
What regional anaesthesia can be provided during childbirth to help pain management?
Epidural anaesthesia (most common for vaginal deliveries)
Spinal block (used especially for C-sections)
Pudendal nerve block (used for episiotomies or when epidural and spinal block not reccomended)
How does epidural anaesthesia work?
Anaesthesia injected in epidural space (outside dura)
What are complications of epidural anaesthesia?
Hypotension
Loss of motor function
How does spinal block work?
Anaesthesia injected directly into subarachnoid space
What are complications of spinal block?
Post-dural headache
Short duration vs epidural
Epidural vs spinal block
Epidural +ve:
Longer lasting (suitable for vaginal deliveries)
Can adjust level and duration
Epidural -ve:
More likely to cause hypotension
Causes loss of motor function
Slow onset
Spinal block +ve:
Less likely to cause hypotension
Motor functions intact
Faster onset
Spinal block -ve:
Short duration
More likely to cause post-dural headaches
Cant adjust doses
