Obstetric Analgesia

Question 1

List some non-pharmacological pain-relief methods used peri-partum

Answer 1

Support, TENS, acupuncture, environment, movement and position, water immersion, aromatherapy, hypnosis, relaxation and breathing, music

Question 2

What inhalational analgesic agents are used during labour?

Answer 2

Nitrous oxide

Question 3

What are the groups of options for pharmacological analgesia during labour?

Answer 3

• Inhaled analgesia (not normally full pain-relief)
• Systemic (e..g opioids, normally only if regional not possible)
• Regional (e.g. neuraxial)
• Local (e.g. nerve blocks)

Question 4

Where is a spinal anaesthetic introduced? How much?

Answer 4

• T10 (vaginal), T4 (CS)
• Small volume (compared with epidural)

Question 5

What are the main complications of neuraxial anaesthesia?

Answer 5

• Hypotension (sympathetic blockade leads to vasodilation)
  
  • Avoid by preloading, using low dose if possible
  • Treat with fluid, left lateral displacement, pressors
• Total spinal block (hypotension, apnoea)
  
  • Left lateral displacement, ventilate, fluids and pressors
• Urinary retention
  
  • Catheterise
• Dural puncture headache
  
  • CSF leak causes low pressure in space and meningeal traction causes pain
  • Conservative management preferred, else epidural patch (small amount of blood injected into space to form clot)