Pain Management in Pregnancy, Childbirth and Postnatal Flashcards
Name some opioids and what are they?
Opioids are drugs that act on the nervous system to relieve pain. They act on the body's opioid receptors. Morphine Dihydrocodeine Diamorphine Pethidine Codeine
What are the benefits of opioids?
Relaxation/sedation effect
Euphoria
Allows women to sleep
Relatively inexpensive
What are the disadvantages of opioids?
Only moderate pain relief Nausea Vomiting Can cause fainting Reduction in efficiency in 2 hours Reduced respiratory reserve ie asthma Hypotension was be worsened Poor renal function - risk of accumulation and seizures If existing hypothyroid/Addison’s disease may have excessive sedative effects/coma
What is entonox?
50% nitrous oxide
50% oxygen
Most commonly used inhaled analgesia
Away from heat sources
What are the benefits of entonox?
Self administered: sense of control
Rapid excretion from the body
What are the disadvantages of entonox?
head injuries, intoxication and any face injuries
What is the mechanism of action of the entonox?
Share properties of lipid solubility which makes them able to bind to cell membranes at certain sites.
Dependant on:
How concentrated the inspired gaseous mixture is
Pulmonary ventilation which delivers gas to the lungs
Transfer across the respiratory membrane into the bloodstream
Loss of gas into bodily tissues
How soluble it is in blood
Cardiac output and blood supply to the brain
Benefits of paracetamol?
Women are familiar with it
Easily self administered at home
Can also be IV
Excellent safety profile and has the least side effect of intrapartum medication
Disadvantages of paracetamol?
Possible risk of liver, kidney or pancreatic damage (damage to the liver is usually when also taking excessive amount of alcohol).
How do NSAID’s work?
Not recommended for pregnant women, childbirth and postnatally unless benefits overweigh the risks
They work by reducing prostaglandins by inhibiting an enzyme.
What are the maternal and fetal risks of using NSAID’s?
in early pregnancy associated with congenital anomalies- cardiac/respiratory/gastro- intestinal.
Third trimester- ductus arteriosus.
NSAIDS in analgesic doses in pregnancy are also associated with
increased risk of bleeding, miscarriage, prolonged and delayed labour and intrauterine growth
restriction
How can NSAID’s help with pregnancy and postnatal?
Low dosage can be used in pregnancy to reduce the risk of pre eclampsia and thrombosis
During the postnatal period, it can help with mastitis and post-operative care.
What are the commonly used analgesics during and after pregnancy?
paracetamol, inhalation analgesia like Entonox, opioids, regional anaesthesia and NSAIDs in the PN
period.
What is the WHO pain ladder?
World Health Organization- guideline for the use of drugs in the management of pain, a stepwise
approach to the use of analgesics depending on pain severity
What is an epidural and how does it work?
A central nerve block technique involving an injection of local anaesthetic into the epidural space and close to the nerves that transmit pain.
Opiates/analgesics into the epidural space in the spinal column, numbing the discomfort felt in labour
