Pain Relief

Question 1

What are the types of regional anaesthesia?

Answer 1

1. Epidural
2. Spinal
3. Combined

Question 2

What is the difference between an epidural and spinal?

Answer 2

• Epidural = catheter stays in back, ideal for long periods of time, topped up for CS
• Spinal = single injection, standard for operative delivery without epidural

Question 3

What is in an epidural?

Answer 3

Bupivicaine and fentanyl

Question 4

Who can’t have an epidural?

Answer 4

• Patient refusal
• Clotting disorders
• Some cardiac/ neurological conditions
• Some types of back surgery
• If had clexane in last 12 hrs

Question 5

What are some of the complications associated with epidurals?

Answer 5

• Hypotension
• Ineffective
• Neurological problems
• Dural tap
• Abscess/ haematoma

Question 6

What should be done alongside an epidural?

Answer 6

• BP 4x5 mins and then half hourly
• 4x5 min BP every time new dose given
• Fluids

Question 7

What are some complementary therapies that may be used in labour?

Answer 7

• Acupuncture
• Aromatherapy
• Herbal remedies
• Homeopathy
• Reflexology
• Hypnobirthing

Question 8

What are some essential oils used for aromatherapy?

Answer 8

• Camomile
• Lavender
• Grapefruit
• Rose
• Frankincense

Question 9

How should raspberry leaf tea be used?

Answer 9

• From 32/40 (takes a while for it to take effect)

- Thought to make contractions more effective

Question 10

What are the contraindications for raspberry leaf tea?

Answer 10

• Previous preterm birth
• Synto
• Previous CS/ ELCS
• APH

Question 11

Name some common herbal remedies

Answer 11

• Raspberry leaf tea
• Primrose oil
• Castor oil

Question 12

What is homeopathy?

Answer 12

• Using minute doses of substances

- Arnica recommended by homeopaths to treat shock, trauma or bruising postnatally

Question 13

What is reflexology?

Answer 13

The idea that pressure points on the feet represent different organs in the body

Question 14

Describe pethidine

Answer 14

• Opiate
• Anti-emetic should be given with it
• May make baby lethargic if given soon before delivery

Question 15

How often should ranitidine be given for women with an epidural?

Answer 15

6 hourly (150mg)

Question 16

When should antacids be given?

Answer 16

When women are given opioids, and epidural or going for a CS

Question 17

What is a contraindication of an epidural?

Answer 17

Clexane in the last 12 hours

Question 18

What advice should be given to women using entonox?

Answer 18

• Breathe in AND out through tube
• Start breathing when contraction begins, not at the peak
• Don’t use between contractions
• May make you feel sick/ dizzy

Question 19

What is meant by sensory block?

Answer 19

What they can feel (use ice)

Question 20

What is meant by motor block?

Answer 20

How much they can move (ask to mobilise/ straight leg raise)

Question 21

What is an unusual way of assessing if an epidural is working well?

Answer 21

If they have warm feet, due to vasodilation, the block is working well

Question 22

What are the 3 conditions that a patient must be in to have an epidural?

Answer 22

1. Delivery within 48 hours
2. Can sit still
3. Not actively pushing

Question 23

When should feeling ideally start coming back in the legs after an epidural?

Answer 23

Within 2-4 hours from delivery

Question 24

How can epidurals affect labour?

Answer 24

• Associated with delayed 2nd stage

- Associated with raised temps in labour

Question 25

How can epidurals affect the foetus?

Answer 25

• Associated with use of oxytocin drip

- Better APGAR scores

Question 26

What is a PDPH?

Answer 26

Post Dural Puncture Headache:

• Usually diagnosed within 24-48 hours
• Can cause neck pain at front and back
• Photophobia
• Nausea
• Tinnitus
• Treated using a blood patch

Question 27

How does a blood patch work?

Answer 27

Another epidural is inserted in the same space and Dr inserts blood taken from the patient’s arm to increase BP