Obstetric pain management I

Question 1

What are some non-pharmacological methods used to manage pain in labour?

Answer 1

Good support from professional

Alternative therapies

Hydrotherapy

Massage

TENS (trans-cutaneous electrical nerve stimulation)

Question 2

List some systemic analgesics (drugs)used?

Answer 2

Simple:

• Paracetamol
• codeine

Opioids:

• pethidine
• morphine
• PCA fentanyl

Question 3

What is PCA?

Answer 3

Patient controlled analgesia

Given via IV, patient controls how much they have (within reason)

It is usually fentanyl or a similar variant

Question 4

What does gas & air consist of?

Answer 4

50% NO and 50% oxygen

Question 5

Which regional analgesic techniques are used in labour?

Answer 5

Epidural

Spinal injection

Combined spinal epidural

Question 6

Where is an epidural given?

Answer 6

In the epidural space

• outside the spinal cord
• outside the dura
• between dura and bone

At the level of the iliac crests, around L3-L4

Question 7

What are some contraindications of an epidural?

Answer 7

Local infection
Allergy to LA
Fetal distress
Ante-partum haemorrhage
Too close to birth

Some medical conditions you need to be extra careful (coagulopathy, systemic infection)

Question 8

What is actually inserted in an epidural?

Answer 8

Local anaesthetic

Something ending in -caine

Question 9

What is a ‘spinal’?

Answer 9

A nerve block, an injection of local anaesthesia into the spinal space (below the end of the spinal cord (the conus medullaris)

So through the meninges

Question 10

What level is the conus medullaris?

Answer 10

L1-L2

Question 11

What is a combined spinal epidural?

When would it be used?

Answer 11

Both an epidural and spinal

For a C section that could take a long time

Question 12

When would a general anaesthetic be used for a C section?

Answer 12

If there’s imminent danger to the fetus or mother

Contra-indication to regional

Failed regional

Question 13

What is different about anaesthetising a pregnant woman compared with a normal patient?

Answer 13

Increased risks

Need to do a rapid sequence induction, because they’re always considered to have not fasted because of increased pressure in abdomen and because of delayed gastric emptying

A rapid sequence induction is when pressure is put on the cricoid area to prevent aspiration of stomach contents

Question 14

What are some common complications of epidural?

Answer 14

Hypotension
Headache
Urinary retention
Doesn't work
Delayed second stage