Obstetric Anaesthesia

Question 0

What pharmacological methods of pain relief may be used in labour

Answer 0

Entonox - side effects include feeling faint, nausea and vomiting

Pethidine IM - onset in 15 mins, lasts 3-4 hours, given with antiemetic

Question 1

What nonpharmacological methods may be used to reduce pain in labour?

Answer 1

Patient education before - breathing techniques etc
Birth partner
Warm bath
Acupuncture
Hypnosis
Homeopathy
TENS machine

Question 2

What are the advantages of epidural?

Answer 2

Effective analgesia for labour
Can be topped up if complications
Can be topped up for post op analgesia
May reduce BP, which is useful in pre-eclampsia

Question 3

What are the disadvantages and complications to epidural?

Answer 3

Failure to site
Patchy or incomplete block 
Hypotension
Decreased mobility
No long term back ache 
Inadvertent dural puncture (1 in 100)
Respiratory depression - if catheter migrates to subarachnoid space then spinal anaesthesia 

Rarely:
Epidural abscess
Epidural haematoma
Damage to nerves or the spinal cord itself

Question 4

What are the contraindications for epidural?

Answer 4

Septicaemia
Infection at site of insertion
Coagulopathy or low platelets
Raised ICP

Do platelets before!

Question 5

What is the most common form of regional anaesthetic technique for CS?

Answer 5

Spinal

Question 6

What anaesthetic techniques may be used for CS?

Answer 6

Spinal
Epidural
Combined spinal epidural
General anaesthetic

Question 7

What are the advantages and disadvantages of spinal for CS?

Answer 7

Advantage:
technically easier than epidural
Reliably establishes dense, bilateral block

Disadvantages :
May cause hypotension
May wear off if surgery is prolonged

Question 8

What are the advantages and disadvantages of combined spinal epidural for CS?

Answer 8

Advantages:
Epidural can top up the block
Smaller volume of anaesthetic is used
Epidural component provides post op analgesia

Disadvantages;
Higher risk of spinal component failure
Higher risk of meningitis
Epidural component is untested and thus doses must be given in small boluses!