Anatomy of Anaesthesia and Labour

Question 1

What type of nerves carry pain signals from the ovaries, fallopian tubes and uterus?

Answer 1

Visceral afferents

Question 2

Where do visceral afferents carrying signals from the superior aspect of the pelvic organs (ie the part touching the peritoneum) enter the spinal cord?

Answer 2

T 11 - L2

Question 3

Where do visceral afferents carrying signals from the inferior aspect of the pelvic organs (ie the part not touching the peritoneum) enter the spinal cord?

Answer 3

S2, 3 and 4

Question 4

If a patient has suprapubic pain, between what levels are the visceral afferents entering the spinal cord?

Answer 4

T 11 - L2

Question 5

If there is inflammation of the uterus or fallopian tubes, where will the patient feel pain?

Answer 5

Suprapubic pain

Question 6

What nerves do visceral afferents from the superior aspect of the pelvic organs run alongside to get to the spinal cord?

Answer 6

Sympathetic fibres

Question 7

What nerves do visceral afferents from the inferior aspect of the pelvic organs run alongside to get to the spinal cord?

Answer 7

Parasympathetic fibres

Question 8

If there is inflammation of the cervix or superior vagina, where will the patient feel pain?

Answer 8

In the S2, 3, 4 dermatome.

Question 9

If the patient has inflammation in the lower aspect of the vagina where will they feel pain?

Answer 9

Localised pain

Question 10

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

Answer 10

L2

Question 11

What level does the subarachnoid space end at?

Answer 11

S2

Question 12

List the layers that the needle passes through when performing a spinal anaesthetic?

Answer 12

supraspinous ligament
interspinous ligament
ligamentum flavum
epidural space (fat and veins)
dura mater
arachnoid mater
finally reaches subarachnoid space (contains CSF)

Question 13

Where is a spinal anaesthetic inserted into?

Answer 13

Subarachnoid space

Question 14

Where is an epidural inserted into?

Answer 14

The epidural space

Question 15

What does the epidural space mostly contain?

Answer 15

Fat and veins

Question 16

Lis the layers that the needle has to pass through in an epidural anaesthetic?

Answer 16

supraspinous ligament
interspinous ligament
ligamentum flavum
epidural space (fat and veins)

Question 17

Why does a spinal anaesthetic cause hypotension?

Answer 17

Spinal nerves and their named nerves all contain sympathetic fibres. Spinal anaesthetic blocks all sympathetic tone to all arterioles in the lower limb causing massive vasodilation and hypotension.

Question 18

What are the nerve roots of the pudendal nerve?

Answer 18

S2, 3 and 4

Question 19

When would you use a pudendal nerve block?

Answer 19

Episiotomy
Forceps use
Stitching post delivery

Question 20

Describe the course of the pudendal nerve

Answer 20

1. Exits the pelvis via the greater sciatic foramen
2. Passes posterior to the sacrospinous ligament
3. Re enters the pelvis via the lesser sciatic foramen
4. Travels in the pudendal canacl
5. Branches to supply the structures of the perineum

Question 21

List the contents of the pudendal canal

Answer 21

Internal pudendal artery and vein
Pudendal nerve
Nerve to the obturator internus

Question 22

What aspect of what ligament does the pudendal nerve cross?

Answer 22

Sacrospinous ligament

Question 23

What bony landmark is used in pudendal nerve block?

Answer 23

Ischial spine

Question 24

What vertebral level is at the same level as the most superior point on the iliac crests?

Answer 24

L4

Question 25

What space is an episiotomy made into?

Answer 25

Ischioanal space

Question 26

What is the ischioanal spcae filled with?

Answer 26

Fat