Pain Relief in Labour

Question 1

What are the four pain relief medications for labour?

Answer 1

Entonox (Gas & Air)

Diamorphine

Remifentanil

Epidural

Question 2

What is entonox?

Answer 2

A mixture of 50% nitrous oxide and 50% oxygen

Question 3

Is entonox a short term or long term pain relief?

Answer 3

Short term

Question 3

How do patients use entonox?

Answer 3

The patient takes deep breaths using a mouthpiece at the start of a contraction, then stops using it as the contraction eases

Question 4

Why is entonox an advantageous pain relief method during labour?

Answer 4

It can be used with most other pain-relieving methods, including diamorphine injections, remifentanil and epidural

Question 5

What are the four side effects of etonox?

Answer 5

Light-Headedness

Nausea

Dry Mouth

Sleepiness

Question 6

What class of medication is diamorphine?

Answer 6

Opioid

Question 7

How do we administer diamorphine?

Answer 7

intramuscular injection into the thigh or buttock

Question 8

How long does diamorphine work after administration?

Answer 8

30 minutes

Question 9

How long do the effects of diamorphine last?

Answer 9

Between 2 to 4 hours

Question 10

Why do we not prescribe diamorphine in the second stage of labour?

Answer 10

The effects last between two to four hours, which can be dangerous when the woman starts to push

Question 11

What are the four side effects of diamorphine?

Answer 11

Drowsiness

Nausea

Neonatal Respiratory Depression

Neonatal First Feed Complications

Question 12

How is remifentanil administered?

Answer 12

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

Question 13

Is remifentanil a short term or long term pain relief?

Answer 13

Short term

Question 14

How long does remifentanil work after administration?

Answer 14

A minute

Question 15

What is the maximum dose of remifentanil that can be administered?

Answer 15

A maximum of one dose can be administered every two minutes

Question 16

What are the four side effects of remifentanil?

Answer 16

Drowsiness

Nausea

Itchiness

Respiratory depression

Question 17

How do we manage the side effect of remifentanil - respiratory depression?

Answer 17

During administration patients are attached to oxygen, with their saturations being monitored regularly via an oximeter

Question 18

When can we not prescribe remifentanil?

Answer 18

When patients have received diamorphine within the last four hours

Question 19

How do we administer an epidural?

Answer 19

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

Question 20

What are the local anaesthetic medications used in epidural?

Answer 20

Levobupivacaine or bupivacaine usually mixed with fentanyl

Question 21

How are the doses of an epidural administered?

Answer 21

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

Question 22

What is the most effective pain relief method for labour?

Answer 22

Epidural

Question 23

How long does the first dose of epidural work after administration?

Answer 23

20 minutes

Question 24

What are the six side effects of an epidural?

Answer 24

Instrumental Delivery Risk

Prolonged 2nd Labour Stage

Hypotension

Headache

Nerve Damage

Motor Weakness

Question 25

What is a contraindication of epidurals?

Answer 25

Coagulopathy