Anaesthetics

Question 1

Pain first stage of labor

Answer 1

Visceral/cramping
Produced by distension of uterine and cervical mechanorecptors and by us haem is or uterine and cervical tissues
Can be referred to abdo wall, lumbosacral, iliac crests, gluteal area and thighs
T10-L1

Question 2

Pain second stage of labor

Answer 2

Combination of visceral pain and somatic pain
Somatic pain=distribution of vaginal and perineal tissues - transmitted via pudendal nerve
S2-S4

Question 3

Effects of severe labour pain

Answer 3

Increased o2 consumption
Hyperventilation —>hypocarbia and resp alk
Gastric inhibition
Increased gastric acidity
Lipolysis
Increased PVR, CO, BP
Decreased placental perfusion
Incoordinate uterine activity
PP psych effects, PTSD

Question 4

Epidural benefits

Answer 4

Reverses adverse ventilators effects of pain (resp alk and utero-placental vasoconstriction)

Question 5

Contraindications to neuroaxial analgesia in labour

Answer 5

Coagulopathy
Increased intracranial pressure
Skin infection lower back
Abnormal spinal anatomy
Hypovolaemia
Anticoagulant therapy
Stenosis heart lesions
Cardiac instability
Unstable neurological disease
Pt unable to cooperate

Question 6

Pethidine SE

Answer 6

Affect breastfeeding
Serotonergic crisis
Seizures
Toxicity

Question 7

Risk of nerve damage

Answer 7

<1:13000

Question 8

Risk of paralysis

Answer 8

<5:1000000

Question 9

Non-pharmacological analgesia methods

Answer 9

Continuous one-to-one support
(Lower analgesia, lower instrumentals, more satisfaction)
Prenatal information
Music - meta-analysis reduces arousal due to stress
Aromatherapy - improves psychological wellbeing, no benefit in reduction of pain, but one RCT showed reduction in pain intensity
Acupuncture - large amount of bias, but has been shown to reduce pain by 11%
Birthing all - RCT x 1 30-40% reduction in labour pain, shorter first stage, less epi, less CS
TENS- cochrane review - similar pain scores to placebo
Sterile water- some RCT evidence reduce pain by 60%
Biofeedback ?effective
Water immersion - less pain in a meta-analysis
Breathing/relaxation techniques - limited evidence

Question 10

Pharmacological methods

Answer 10

NO - widely used but limited good studies supporting it’s use
Non-opioid analgesics - paracetamol ok
Pethidine - adverse effects on fetus but good pain relief
PCA - failure 1:10, no neonatal effects, not superior to epidural

Question 11

Risks with epidural

Answer 11

1:54000 permanent injury
1:140000 paraplegia or death
Prolonged second stage
Instrumental delivery