intrapartum pt 2: labor pain management Flashcards
EXAM 2 content
what influences pain during labor?
- physical: visceral & somatic pain
- psychosocial: culture, anxiety, past experience, preparation, support & environment
what stage of labor does visceral pain happen? what happens in this pain?
STAGE 1 of labor
- uterine ischemia& distention
- cervical changes
- referred pain
what stage of labor does somatic pain happen? what happens in this pain?
STAGE 2 of labor
- distention & pressure
- traction of peritoneum
- laceration
what do we use to treat pain during labor?
- sedatives: prolonged latent phase
- systemic analgesia: IV meds (crosses placenta)
- inhaled anesthetic
- regional analgesia & anesthesia
- general anesthesia: C/S only
what medications are used for systemic analgesia? what do we need to remember about them?
THEY CROSS THE PLACENTA
- opioid agonist: morphine, Fentanyl, remifentanil (Ultiva)
- opioid agonist-antagonist: Stadol & Nubain
what is the onset, peak, half life & duration of MORPHINE?
IV morphine
- onset: 1-2 mins
- peak: 5-15 mins
- half life: 1.5-2 hours
- duration: 3-4 hours
what is the onset, peak & duration of FENTANYL?
- onset: 5 - 15 mins
- peak: 20-30 mins
- duration: 2 hours
what is the onset, half life & clearance of REMIFENTANIL (Ultiva)?
- onset: 1-2 mins
- half life: 20 mins
- clearance: 40 mins
what medications are under inhaled anesthetics? what is the onet, peak & duration?
NITROUS OXIDE
- does NOT affect baby
- onset: 10 mins
- peak: 30 seconds of last inhalation
- duration: lasts until gas flow is off but once it is off it 5-10 mins to leave the system
what medications are under regional analgesia & anesthesia?
- blocks: PUDENDAL – local tissue
- spinal anesthesia: epidural & spinal block (C/S)
what is a pudendal block used for?
used for extensive repair if no epidural yet
what bone is the pudendal nerve near?
ischial spine & sacrospinous ligament
what is the difference between a spinal block & epidural?
spinal block = inserted at subarachnoid space
epidural block = inserted at epidural space
when is an epidural given? what does it help with? when is it contraindicated? what should you do prior to inserting? does it affect the baby?
- given when mom is 3-4 cm dilated
- help with pain
- usually use a lidocaine patch to numb area of where needle is inserting
- monitor FHR during insertion
- contraindicated when mom has had many significant surgeries
- it does NOT affect the baby
what is the gate control theory?
distraction techniques are able to block some of the sensory messages to the nerve pathways
- activities involving spinal cord
- cognitive work: concentration on breathing
