Pain Management

Question 1

What analgesia is suggested for early established labour?

Answer 1

1. Morphine 10-15 mg IM combined with aterax 50-100mg

2. Pethidine 75- 100 mg IM combined with aterax 50-100 mg

Question 2

What is suggested analgesia for established labour?

Answer 2

1. Entonox

2. Epidural analgesia

Question 3

What are particular indications for epidural anesthesia?

Answer 3

1. Trial of labour in primi gravida
2. Prolonged labour anticipated
3. Malpresentation and twin pregnancy
4. Incoordinate uterine action
5. Uncomplicated severe pre- eclampsia in the absence of thrombocytopenia or coagulopathy because one can treat hpt and pain.

Question 4

Possible analgesia late in labour

Answer 4

1. Epidural analgesia
2. Pethidine 25- 50 mg or morphine 3-5 mg given over 10 minutes via iv injection
3. . Single shot spinal analgesia

Question 5

What drugs are used for spinal anesthesia

Answer 5

Bupivacaine 2.5 mg

Fentanyl 10-20 ug

Question 6

Contra indications to epidural blockade

Answer 6

Absolute: 
1. Patient refusal 
2. Inadequate resus equipment 
3. Coagulopathy or thrombocytopenia 
4. Active or uncontrolled haemorrhage 
5. Known allergy to anaesthetic drugs 
6. Local skin sepsis in lumbo- sacral region 
Relative 
1. Advanced aortic or mitral stenosis 
2. Active neurological disorders or spinal abnormalities 
3. Eclampsia

Question 7

What is the treatment of a Dural puncture resulting in subarachnoid injection of local anaesthetic?

Answer 7

Ephedrine 10-20 mg
Rapid infusion of iv crystalloid solution to restore blood pressure
Endotracheal intubation and ventilation in the setting of diaphragmatic paralysis

Question 8

Consequences and treatment of intravenous injection of local drug during an epidural blockade

Answer 8

• causes neurological and cardiac toxic overdose with convulsions and cardiac collapse
• treatment: intralipid, advanced cardiac life support

Question 9

What are 3 pharmacological techniques of analgesia in labour?

Answer 9

1) systemic opiates and sedatives
2) inhalational analgesia with entonox
3) regional neural conduction blockade

Question 10

What are indications for combined spinal epidural analgesia?

Answer 10

Women in severe pain 
Late first labour 
Malpresentations 
2nd stage fetal distress 
Unsatisfactory epidural 
Obese women

Question 11

Common complications of epidural analgesia

Answer 11

Hypotension
Nausea
Vomiting 
Sedation 
Shivering 
Modest increase in body temp 
Motor weakness

Question 12

What are the consequences and treatment of inadvertent Dural puncture?

Answer 12

• subarachnoid injection of local anaesthetic drug causing high or even total spinal anaesthesia, resulting in severe hypotension and respiratory paralysis
• tx: ephedrine 10-20 mg; rapid infusion of IV crystalloid solution to restore blood pressure and cardiac output