Pain Relief in Labour Flashcards
What are the four pain relief medications for labour?
Entonox (Gas & Air)
Diamorphine
Remifentanil
Epidural
What is entonox?
A mixture of 50% nitrous oxide and 50% oxygen
Is entonox a short term or long term pain relief?
Short term
How do patients use entonox?
The patient takes deep breaths using a mouthpiece at the start of a contraction, then stops using it as the contraction eases
Why is entonox an advantageous pain relief method during labour?
It can be used with most other pain-relieving methods, including diamorphine injections, remifentanil and epidural
What are the four side effects of etonox?
Light-Headedness
Nausea
Dry Mouth
Sleepiness
What class of medication is diamorphine?
Opioid
How do we administer diamorphine?
intramuscular injection into the thigh or buttock
How long does diamorphine work after administration?
30 minutes
How long do the effects of diamorphine last?
Between 2 to 4 hours
Why do we not prescribe diamorphine in the second stage of labour?
The effects last between two to four hours, which can be dangerous when the woman starts to push
What are the four side effects of diamorphine?
Drowsiness
Nausea
Neonatal Respiratory Depression
Neonatal First Feed Complications
How is remifentanil administered?
It is a patient controlled intravenous drug.
This involves patients pressing a button at the start of a contraction to administer a bolus of this medication through a drip attached to the back of the hand
Is remifentanil a short term or long term pain relief?
Short term
How long does remifentanil work after administration?
A minute
What is the maximum dose of remifentanil that can be administered?
A maximum of one dose can be administered every two minutes
What are the four side effects of remifentanil?
Drowsiness
Nausea
Itchiness
Respiratory depression
How do we manage the side effect of remifentanil - respiratory depression?
During administration patients are attached to oxygen, with their saturations being monitored regularly via an oximeter
When can we not prescribe remifentanil?
When patients have received diamorphine within the last four hours
How do we administer an epidural?
We insert a catheter into the epidural space in the lower back.
This is outside the dura mater, separate from the spinal cord and CSF
Local anaesthetic medications are then infused through the catheter into the epidural space, where they diffuse to the surrounding tissues and through the spinal cord
What are the local anaesthetic medications used in epidural?
Levobupivacaine or bupivacaine usually mixed with fentanyl
How are the doses of an epidural administered?
The epidural catheter will be attached to an epidural pump, which will administer small doses of medicine throughout labour
The patient can also administer additional doses by pressing a button attached to the epidural tube
Due to patient safety, a maximum dose is set
What is the most effective pain relief method for labour?
Epidural
How long does the first dose of epidural work after administration?
20 minutes
What are the six side effects of an epidural?
Instrumental Delivery Risk
Prolonged 2nd Labour Stage
Hypotension
Headache
Nerve Damage
Motor Weakness
What is a contraindication of epidurals?
Coagulopathy
