Anatomy 7: Anaesthesia for Labour

Question 1

With regards to pain sensation from the female reproductive system, where are the two important areas?

Answer 1

T11-L2

S2-S4

Question 2

From organs do visceral afferents travel back to T11-L2?

Answer 2

Those pelvic organs which touch the peritoneum

• Uterine tubes
• Uterine body
• Ovaries
• Pain presents as a vague lower abdominal pain

Question 3

From organs do visceral afferents travel back to S2-S4?

Answer 3

From those organs within the pelvis but inferior to the peritoneum

• Cervix
• Superior vagina

Question 4

From organs do visceral afferents travel back vis Pudendal to S2-S4?

Answer 4

From those organs/structures within the perineum

• Inferior vagina
• Perineal muscles, glands
• Skin

Pain presents as a sharp, well localised pain

Question 5

Where is spinal anaesthetic injected?

Answer 5

Into L3-L5 region

Question 6

At what spinal level does the subarachnoid space end?

Answer 6

S2

Question 7

What layers does the needle pass in spinal anaesthesia?

Answer 7

1. Supra and then interspinous ligaments
2. Ligamentum Flavum
3. Epidural Space
4. Dura mater
5. Arachnoid mater

Question 8

What are the signs that the spinal anaesthetic is working (Hypotension)?

Answer 8

Blockage of “sympathetic tone” to all arterioles in lower limbs:

Vasodilation
Skin of lower limbs look flushed
Warm lower limbs
Reduced sweating

Question 9

Branches of the pudendal nerve?

Answer 9

S2,3,4

A named branch from the sciatic

Question 10

What is the course of the pudendal nerve?

Answer 10

Leaves through the greater sciatic foramen and enters via the lesser sciatic foramen to enter the perineum

Question 11

At what level does the spinal cord become the cauda equina?

Answer 11

L2