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A - MSRA Obstetrics [16] > [39] Analgesia and Anaesthesia During Labour > Flashcards

[39] Analgesia and Anaesthesia During Labour Flashcards

1
Q

When should strategies for the relief of pain during labour be discussed with the mother?

A

During the antenatal period

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2
Q

What are the techniques for relieving pain during labour aimed at?

A

Reducing the level of pain experienced in labour whilst invoking minimal risk for the mother and her baby

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3
Q

How does the level of pain experienced during labour vary?

A

Varies widely, with some experiencing very little pain, whilst others suffer from abdominal or back pain of increasing intensity throughout their labour

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4
Q

What is the result of the wide variety in pain experienced during labour?

A

Any programme of pain relief must be tailored to the individual

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5
Q

What is the best mode of pain relief in labour advised based on?

A
  • If the mother is nulliparous or multiparous
  • Current cervical dilatation
  • Rate of progress in labour
  • Extent to which the mother is feeling the pain
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6
Q

How is a decision regarding pain relief in labour reached?

A

The mother decides based on the advice given

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7
Q

What does the programme of pain relief in labour often involve?

A

A combination of methods, starting from least to most effective method

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8
Q

What is the only method of pain relief during labour that provides complete pain relief during labour?

A

Epidural anaesthesia

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9
Q

What are the types of pain relief during labour?

A
  • Narcotic analgesia
  • Inhalation analgesia
  • Complementary therapies
  • Regional anaesthesia
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10
Q

What are the options for narcotic pain relief during labour?

A
  • Pethidine
  • Morphine
  • Remifentanil
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11
Q

Is remifentanil widely used?

A

I dont think so it just says some centres so probs not a main one

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12
Q

What is the advantage of remifentanil?

A

It is an ultra short-acting opioid that produces a superior analgesia to pethidine and has less of an effect on neonatal respiration

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13
Q

What are the common side effects of opiates?

A
  • Nausea and vomiting in the mother

- Respiratory depression in the baby

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14
Q

When is the effect of opiates on the neonatal particularly important?

A

When the drug is given within 2 hours of delivery

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15
Q

What are opiates often administered with?

A

Anti-emetics

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16
Q

What effect might using opiates during labour have after labour?

A

Might interfere with breastfeeding

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17
Q

When is inhalation analgesia used in labour?

A

Early in labour, until the mother switches to much stronger analgesics

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18
Q

What is inhalational analgesia best used for in labour?

A

Short-term pain relief in the late first and second stage of labour

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19
Q

What is the most widely used inhalation analgesia used in labour?

A

Entonox

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20
Q

What is Entonox?

A

A 50/50 mixture of nitrous oxide and oxygen

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21
Q

What is the advantage of Entonox in labour?

A

The gas is self administered, which avoids overdosing as they drop the mask off

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22
Q

When is Entonox inhaled?

A

As soon as the contraction starts

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23
Q

Who has nitrous oxide been shown to have adverse effects on?

A

Birth attendants

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24
Q

When does nitrous oxide have adverse effects on birth attendants?

A

If exposure is prolonged

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25
Q

What adverse effects might nitrous oxide have on birth attendants?

A
  • Decreased fertility
  • Bone marrow changes
  • Neurological changes
26
Q

How are the adverse effects of nitrous oxide on birth attendants avoided?

A

Forced air change every 6-10 hours, which is effective in reducing nitrous oxide levels

27
Q

What complementary therapies are there for pain relief in labour?

A
  • Breathing and relaxation techniques
  • Massage techniques taught to birth companions
  • Acupuncture
28
Q

Should you offer acupunture as analgesia during labour?

A

Do not offer, but do not stop the woman doing it if she wants

29
Q

How is immersion in water during labour claimed to provide analgesia?

A

Increases maternal relaxation and reduces analgesic requirements

30
Q

When is immersion in water during labour supported?

A

For healthy women with uncomplicated pregnancies

31
Q

What did a Cochrane review find regarding the use of immersion in water during labour?

A

It reduces the use of analgesia and reported maternal pain, without adverse effects on labour duration, operative delivery, or neonatal outcome

32
Q

What is the most effective and widely used pain relief during labour?

A

Epidural (obviously)

33
Q

In what % of labouring women does epidural provide complete pain relief?

A

95%

34
Q

When during labour can an epidural be inserted?

A

Any time

35
Q

Do epidurals interfere with uterine contractility?

A

No

36
Q

What is the problem with epidural, in terms of the progress of labour?

A

It may reduce the desire to bear down in the second stage of labour

37
Q

Why might an epidural reduce the desire to bear down in the second stage of labour?

A

Due to lack of pressure sensation at the perineum, and reduced uterine activity due to loss of the Ferguson reflex

38
Q

What is the Ferguson reflex?

A

Increased uterine activity due to reflex release of oxytocin due to the presenting part stretching the cervix and upper vagina

39
Q

How is an epidural inserted?

A

A fine catheter is introduced into the lumbar epidural space, which is then preloaded with no more than 500ml of saline or Hartmann’s solution. Then, a local anaesthetic agent such as bupivacaine is injected, at the minimum dose required for effective pain relief

40
Q

Where is the lumbar epidural space?

A

L3-4 interspace

41
Q

What is the advantage of the addition of an opioid to the local anaesthetic in epidural?

A

It greatly reduces the dose requirement of bupivacaine, thus sparing the motor fibres to the lower limbs and reducing the classic complications of hypotension and abnormal fetal heart rate

42
Q

What monitoring should be done in a patient who has had an epidural?

A
  • BP
  • Pulse rate
  • Fetal heart rate
43
Q

Why might the maternal position need to be adjusted with an epidural?

A

To achieve desired analgesic effect

44
Q

What are the complications of epidural anaesthesia?

A
  • Hypotension
  • Accidental dural puncture
  • Post-dural headache
45
Q

How can hypotension caused by epidural anaesthesia be avoided?

A
  • Pre-loading

- The use of low-dose anaesthetic agents and opioid solutions

46
Q

What % of epidurals does accidental dural puncture occur in?

A

Less than 1%

47
Q

What % of mothers will develop a headache if a 16 or 18 gauge needle is used for epidural?

A

70%

48
Q

What should be done if a post-dural headache persists for more than 24 hours?

A

Should be treated with an epidural blood patch

49
Q

What are the contraindications for epidural?

A
  • Maternal refusal
  • Coagulopathy
  • Local or systemic infection
  • Uncorrected hypovolaemia
  • Inadequate or inexperienced staff or facilities
50
Q

When is spinal anaesthetic commonly used in delivery?

A

For operative delivery

51
Q

Why is spinal anaesthetic not used for pain relief in labour?

A

Due to the superior safety of epidural anaesthesia, and the ability to top epidural up with suitable doses or as continuous infusion to get pain relief over a long period of time

52
Q

When can local anaesthetic be useful in delivery?

A

For women who have not had an epidural, but require forceps or vacuum extraction delivery, or for repair of episiotomy tear

53
Q

What are the most commonly performed local anaesthetic nerve blocks in delivery?

A
  • Paracervical blockage

- Pundendal nerve blockade

54
Q

What does a paracervical blockade involve?

A

Infiltration of local anaesthetic agents into the paracervical tissues

55
Q

What is the limitation of a paracervical blockage for childbirth?

A
  • Rarely used for obstetric procedures

- Greater chance of side effects to the fetus should it enter a vessel

56
Q

What does a pundendal nerve blockade involve?

A

Infiltration around the pundendal nerve as it leaves the pundendal canal and inferior haemorrhoidal nerve

57
Q

Describe the use of a pundendal nerve blockade?

A

It used to be used a lot in operative vaginal deliveries, but now used less frequently and has been replaced by epidural anaesthesia

58
Q

What is often used when giving local anaesthesia for episiotomy or tear repair?

A

Infiltration directly into the perineal tissues over the site

59
Q

What care should be taken when diving local anaesthesia over the perineal tissues for episiotomy or tear repair?

A

Not to accidentally inject the drug IV

60
Q

What might happen if you accidentally inject local anaesthetic IV during episiotomy or perineal tear repair?

A

May get toxic symptoms such as cardiac arrhythmias and convulsions, especially with larger dosage

A - MSRA Obstetrics [16] (61 decks)

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