Pain Relief Flashcards
What are the types of regional anaesthesia?
- Epidural
- Spinal
- Combined
What is the difference between an epidural and spinal?
- Epidural = catheter stays in back, ideal for long periods of time, topped up for CS
- Spinal = single injection, standard for operative delivery without epidural
What is in an epidural?
Bupivicaine and fentanyl
Who can’t have an epidural?
- Patient refusal
- Clotting disorders
- Some cardiac/ neurological conditions
- Some types of back surgery
- If had clexane in last 12 hrs
What are some of the complications associated with epidurals?
- Hypotension
- Ineffective
- Neurological problems
- Dural tap
- Abscess/ haematoma
What should be done alongside an epidural?
- BP 4x5 mins and then half hourly
- 4x5 min BP every time new dose given
- Fluids
What are some complementary therapies that may be used in labour?
- Acupuncture
- Aromatherapy
- Herbal remedies
- Homeopathy
- Reflexology
- Hypnobirthing
What are some essential oils used for aromatherapy?
- Camomile
- Lavender
- Grapefruit
- Rose
- Frankincense
How should raspberry leaf tea be used?
- From 32/40 (takes a while for it to take effect)
- Thought to make contractions more effective
What are the contraindications for raspberry leaf tea?
- Previous preterm birth
- Synto
- Previous CS/ ELCS
- APH
Name some common herbal remedies
- Raspberry leaf tea
- Primrose oil
- Castor oil
What is homeopathy?
- Using minute doses of substances
- Arnica recommended by homeopaths to treat shock, trauma or bruising postnatally
What is reflexology?
The idea that pressure points on the feet represent different organs in the body
Describe pethidine
- Opiate
- Anti-emetic should be given with it
- May make baby lethargic if given soon before delivery
How often should ranitidine be given for women with an epidural?
6 hourly (150mg)
When should antacids be given?
When women are given opioids, and epidural or going for a CS
What is a contraindication of an epidural?
Clexane in the last 12 hours
What advice should be given to women using entonox?
- 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
What is meant by sensory block?
What they can feel (use ice)
What is meant by motor block?
How much they can move (ask to mobilise/ straight leg raise)
What is an unusual way of assessing if an epidural is working well?
If they have warm feet, due to vasodilation, the block is working well
What are the 3 conditions that a patient must be in to have an epidural?
- Delivery within 48 hours
- Can sit still
- Not actively pushing
When should feeling ideally start coming back in the legs after an epidural?
Within 2-4 hours from delivery
How can epidurals affect labour?
- Associated with delayed 2nd stage
- Associated with raised temps in labour
How can epidurals affect the foetus?
- Associated with use of oxytocin drip
- Better APGAR scores
What is a PDPH?
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
How does a blood patch work?
Another epidural is inserted in the same space and Dr inserts blood taken from the patient’s arm to increase BP
