Pain Relief in Labour

Question 1

Describe water birth

Answer 1

Reduces ned for regional anaesthesia
Recommended - water temperature checked hourly
Kept < 37.5 degrees to prevent maternal pyrexia
Usually not possible for high risk woman on continuous monitoring to labour in water due to technical difficulties with CTG equipment

Question 2

What are pharmacological methods of pain relief in labour?

Answer 2

Nitrous oxide
Narcotic agents
Pudendal nerve block
Local anaesthesia (lidocaine)

Question 3

Describe nitrous oxide? CI? SE?

Answer 3

(50% in O2 = entonox)
Inhaled throughout labour and demand led
CI - pneumothorax
Short onset of action and half life
SE - nausea, vomiting, feeling faint

Question 4

What narcotic agents can be used in labour? SE? What should be prescribed alongside?

Answer 4

Pethidine and diamorphine
SE for mother: drowsiness, nausea, vomiting
SE for baby: short term respiratory depression, drowsiness

If given IM/IV, must be prescribed with anti-emetic

Pethidine IM + cyclizine IM is most commony used

Question 5

What is pudendal nerve block? Roots?

Answer 5

1% lidocaine injected 1cm beyond a point just below and medial to ischial spine on each side

Used with perineal infiltration for instrumental delivery but analgesia is insufficient for rotational forceps

Sacral nerve roots 2,3,4

Question 6

When is local anaesthesia used?

Answer 6

Lidocaine

Infiltrated into perineum before episiotomy at time of delivery and before suturing vaginal tears

Question 7

What are different types of regional anaesthesia used in labour?

Answer 7

Epidural anaesthesia
Combined spinal epidural anaesthesia
Spinal anaesthesia

Question 8

What is epidural anaesthesia? Complications

Answer 8

Pain fibres carried by T10-S5 infiltrated
Can be topped up - catheter is left in epidural space

Complications:
Failure to site
Patchy block
Hypotension
Dural picture
Nerve damage

Question 9

What should you check before an epidural? Where do you insert?

Answer 9

Platelets > 75x10^9

L3/L4 space

Question 10

What should you do once epidural is inserted?

Answer 10

Record BP every 5min for 20min
Record block height and density
CTG is required
Give IV fluids if maternal hypotension

Top-up 2 hourly

Question 11

How should you alter anticoagulation when doing epidural?

Answer 11

Wait 12h after heparin dose before inserting block or removing catheter
(24h if on therapeutic dose rather than prophylactic dose)
Wait 4 hours after block siting before next LMWH dose

Question 12

What anaesthesia is used for most CS?

Answer 12

Spinal anaesthesia

Reliable dense block

Question 13

Where does spinal anaesthesia go?

Answer 13

Into CSF

Question 14

What is difference between spinal and epidural

Answer 14

E: Slow onset (25m)
S: Fast onset (5m)

E: Any level
S: Below L1/L2

E: Epidural space - without puncture of dura
S: Subarachnoid space - puncture of dura

E: Loss of resistance technique
S: When CSF appears

E: Hypotension slow
S: Hypotension rapid

E: 15-20ml bupivicaine, can be topped up
S: 2.5-3.5ml bupivicaine, one off injection for 2h