Pain Relief in Labour

Question 1

What type of pain relief is avoided in pregnancy?

Answer 1

NSAIDs

Question 2

What pain relief is used in early labour?

Answer 2

simple analgesia

• paracetamol is first-line choice
• codeine may be added for additional affect

Question 3

What is entonox and when is it used?

Answer 3

• also known as “gas and air”
• it is 50% oxygen and 50% nitrous oxide
• it is used for short term pain relief during contractions

Question 4

How is entonox administered?

Answer 4

• the woman takes deep breaths using a mouthpiece at the start of a contraction
• they stop using it as the contraction eases

Question 5

What are the side effects of entonox?

Answer 5

• lightheadedness
• nausea
• sleepiness

Question 6

How and why might IM opioids be given?

Which opioids are given?

Answer 6

pethidine / diamorphine

• given as IM injections to help with anxiety / distress

Question 7

What are the side effects of IM pethidine / diamorphine?

Answer 7

• they can cause drowsiness / nausea
• they should NOT be given too close to birth as they can cause respiratory depression in the neonate
• their use may make the first feed more difficult

Question 8

When might patient-controlled analgesia be used in labour?

Answer 8

IV remifentanil

• the woman presses a button at the start of a contraction to release a bolus of short-acting opioid

Question 9

What additional measures must be in place if PCA is being used?

Answer 9

• requires anaesthetic input
• access to naloxone in case of respiratory depression
• access to atropine in case of bradycardia

Question 10

What is an epidural and how is it inserted?

Answer 10

• a small catheter is inserted into the epidural space
• this is OUTSIDE of the dura mater
• local anaesthetic medications are infused through the catheter into the epidural space
• they will diffuse through to the spinal cord

Question 11

What anaesthetic medications are usually given in an epidural?

Answer 11

• levobupivacaine + fentanyl

OR

• bupivacaine + fentanyl

Question 12

What is the most significant adverse effect associated with an epidural?

Answer 12

• the second stage of labour can be prolonged
• there is an increased probability of instrumental delivery being required

Question 13

What are the other adverse effects associated with an epidural?

Answer 13

• headache after insertion
• motor weakness in the LLs
• nerve injury
• hypotension

Question 14

How is significant motor weakness following epidural insertion assessed?

Answer 14

• if the woman is unable to straight leg raise
• the catheter may be incorrectly sited in the subarachnoid space