Analgesia for labour – an evidence-based insight for the obstetrician TOG 2015

Question 1

What spine nerve rooms is pain perceived by in early labour and 2nd stage?

Answer 1

Early labour: T10-L1 (contraction & dilation of Cx)

2nd stage: S2-S4 (pudendal nerve)

Question 2

One-to-one support it labour is associated with what measurable benefits?

Answer 2

• Lower analgesic requirement
• Reduced rate instrumental
• Lower dissatisfaction with labour

Question 3

What website has information about analgesia in multiple languages?

Answer 3

LabourPains.com

Question 4

In a RCT a birthing ball reduced labour pain by how much?

Answer 4

30-40%
Shorter 1st stage
Reduced CS

Question 5

Over what nerve roots is TENs applied?

Answer 5

T10-S2

Question 6

What is the maximum temperature of water poo;?

Answer 6

37.5

Question 7

What is enetonox?

Answer 7

Mixed of NO and oxygen 1:1 ratio.
High doses - very weak anaesthetic
Low doses - analgesic/anxiolytic

Question 8

Half life of NO

Answer 8

2-3 mins

Question 9

How long can it take for a fetus to fully eleminate methadone?

Answer 9

6 days - resp depression, hypothermia, poor feeding, altered crying, decreased alertness

Question 10

Comparing IM pethadine and IM diamorphine

Answer 10

Diamorphine - better analgesia but prolonged labour by 82 mins

No differences in neonatal outcomes

Question 11

Risk of epidural

Answer 11

1/10 failure to work
Pruritis & shivering
Hypotension 1/50
Headache 1/100
Temporary nerve damage 1/1000
Permananet nerve damage 1/13000
Infection, meningitis, 1/50000

Question 12

Risk Remifentasnil PCA

Answer 12

Failure to work (1 in 10)

Pruritus, nausea and vomiting

Drowsiness and dizziness

Causes neonatal drowsiness

Can cause a reduced respiratory rate with a requirement for supplemental oxygen

Stopping the use of the PCA because of hypoxia and reduced Glasgow Coma Scale (1 in 28 women)

Cardio-respiratory arrest (<1 in 2200)

Fo not need cont CTG

Question 13

What are the contraindication to regional anaesthesia

Answer 13

Maternal refusal
Local & untreated systemic infection
Coaguloaopathy - platelets <80, INR >1.4
Uncontrolled hypovolaemoa/haemorrhage
Expectated of significant haemorrhage
Certain spinal surgery/abnormality
Lack of trained staff

Question 14

Care & observations for regional

Answer 14

• IV access
• No preloading/maintenance fluid
• Check BP every 5 mins for 15 mins during establishment
• Anaethesthetic review after 30 mins in patient no pain free
• Check sensory block hourly
• CTG for 30 mins during establishment or after bolus >10mls

Question 15

Incidence of permanent nerve damage with epidural

Answer 15

1:54000