Pain relief in labour Flashcards
What are the pharmacological options for pain relief
- nitrous oxide
- narcotics: pethidine, diamorphine
- pudendal nerve block w lidocaine
- LA w lidocaine
What are CI of nitrous oxide
pneumothorax
What are SE of nitrous oxide
N&V, feeling faint
What are SE of narcotics for mother
− Drowsiness
− N&V
What are SE of narcotics for baby
− Short term resp depression
− Drowsiness lasting for several days
How should narcotic be given
IM or IV
w antiemetic - cyclizine
What nerves are blocked in pudendal nerve block
sacral nerve roots 2 3 and 4
Where is LA injected
what is it indicated for
perineum
before episiotomy and suturing vaginal tears
What are the three regional anaesthesia options
- epidural
- combined spinal epidural
- spinal
What pain fibres are anaesthetised w an epidural
T10-S5
What are complications of epidural
− Failure to site
− Patchy block
− Hypotension
− Dural puncture
what space is epidural injected into
L3/4
wWhat is a common SE of epidural
fetal bradycardia due to maternal hypotension
How often are top ups of epidural required
every 2 hrs
How long do you have to wait after giving heparin before inserting block
12
How long do you have to wait after block before next dose of LMWH
4h
What is an advantage of combined spinal epidural
gives quicker pain relief
can cover a prolonged CS
When is spinal most commonly used
LSCS
What are disadvantages of spinals
due to being a single injection may wear off if the procedure is prolonged
can cause more profound hypotension compared w epidural
Which pain relief is used to help lower BP in preeclampsia
epidural
What are non-pharmacological forms of pain relief?
- Water birth
2. Transcutaneous electrical nerve stimulation
