Labor and Delivery Analgesia Flashcards
Benefits of pain control
- Decreased suffering
- decreased O2 demand
- decreased catecholamines
- increased satisfaction
- method for c/s as well
Non-pharmacologic options for analgesia
- Hypnosis, hydrotherapy
- acupuncture
- aroma therapy
- breathing techniques
- TENS unit
IV analgesic options
- IV narcotics
- fentanyl
- remifentanil PCA
Paracervical blocks
Not for labor pain
- injected into cervical stroma
- RISK: fetal bradycardia
Pudendal block
S2-4
- Stage 2 labor pain
- sacral sparing
Lumbar sympathetic block
useful for first stage of labor
- doesn’t help with 2nd stage
- similar to paracervical block without fetal bradycardia risk*
Lumbar sympathetic block technique
Percutaneous injection of local around lumbar sympathetic ganglia –> L2-3 level
Inhalational agents for analgesia
N20 –> efficacy is not all that great (modest reductions in pain scores)
–> great maternal satisfaction
Contraindications to neuraxial
- patient refusal
- Infection over site or untreated
- uncorrected hypovolemia
- Tethered cord
- Spina bifida
- Increased ICP
- Coagulopathy
SubQ UFH guidelines
> 4 days –> platelet count
- wait 4-6 hours after for placement
- wait 4-6 hours after dose for removal
SubQ LMWH guidelines
Placement: wait 12 hours
Removal: wait 12 hours
Start med: wait 4 hours after removal and 12 hours after placement
Warfarin guidelines
- 5 days since dose
- Normal INR (1.2)
Does epidural prolong labor?
1st Stage: No –> best data we have says no
2nd Stage: possibly a couple of minutes
First Stage of Labor?
Latent - mom notices regular contractions
Active - onset of contraction until full dilation
Second stage of labor?
full dilation of cervix until birth of baby
Nulliparous - 4 hours
Multiparous - 3 hours
