Pain relief in Labour and Anaesthesia for obstetrics Flashcards
(29 cards)
What are the criteria for ideal pain relief in labour?
- Provides good analgesia
- Safe for baby and mother
- Predictable and constant effects
- Be reversible
- Easy to administer
- Under control of mother
What are non-pharmacologcal methods of pain relief in labour?
- Breathing exercises
- Aromatherapy
- Warm baths
- Acupuncture
- Hypnotherapy
- TENS machine
When is a TENS machine most useful in labour?
Early labour - loses effect as labour progresses
What pharmacological methods can be used in labour for pain relief?
- Entonox gas
- Strong opiates
- Local anaesthesia
- Epidural anaesthesia
- Spinal anaesthesia
What is entonox?
50% nitrous oxide, 50% oxygen
What are the benefits of entonox?
- Self-administered
- Quick onset
- Short half life
What are side effects of entonox?
- Faint
- Nausea
- Vomiting
What opitates are used in labour?
- Pethidine
- Morphine
- Remifentanyl PCA
- Diamorphine
What are side effects to opiods?
- Nausea + vomiting
- Drowsiness
- Resp depression - woman and noenate
What forms of local anaesthesia are most commonly used in labour?
Lignocaine
What are features of local anaesthetic toxicity?
- Perioral tingling
- Praesthesiae
- Confusion
- Drowsiness
- Light-headedness
- Seizures
- Coma
- Cardiac arrest
What is inolved in an epidural anaesthesia?
Injection of local anaesthesia and opiate medication into the epidural space
What are contraindications to epidural anaesthesia?
- Thrombocytopenia
- Coagulopathy
- Raised ICP
- Local sepsis
- Septic chock
- Allergy to local anaesthesia
What are advantages of epidural anaesthesia?
- 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
What are dcomplications of epidural anaesthesia?
- Hypotension
- Epidural haematoma/abscess
- Respiratory depression
- Neurological deficit
- Dural puncture
What fibres are anaesthatised in an epidural nerve block?
T11-S5
What are epidrual anaesthesias useful for managing?
- Breech presentation
- OP position
- Multiple pregnancy
- Preterm delivery
- Pre-eclampsia
- Forceps delivery
Where are local anaesthesia and opiod medications injected for spinal anaesthesia?
Subarachnoid space
What are advantages of spinal anaesthesia?
- Dense, anaesthetic bilateral block
- Can stay awake and maintain own airway
What are disadvantages of spinal anaesthesia?
- Causes hypotension
- Need for urinary catheter
- Risk dural puncture
- Small risk of nerve damage
Where is a pudendal nerve block injected?
1cm beyond a point just below and medial to the ischial spine on each side
What are the main uses for a puedendal nerve block?
Instrumental delivery
What are options for simple anaesthesia during pregnancy?
- Paracetamol
- Dihydrocodeine/Codeine
- Aspirin
When should you avoid aspirin in labour?
Increases bleeding risk
