Pain Relief In Labour Flashcards
Is induction more or less painful than spontaneous labour?
More, especially if augmented with oxytocin
What non-pharmacological methods are there?
Education - reduces fear
Breathing exercises and relaxation techniques
Supportive birthing partner
Acupuncture, homeopathy, hypnosis may be helpful but not offered by nhs
Transcutaneous electrical nerve stimulation - safe and useful esp in short labours, not recommended by NICE in established labour
Water birth - labouring in water has been shown to reduce the need for regional anaesthesia (temp checked hourly and kept less than 37.5 degrees to prevent maternal pyrexia)
What pharmacological methods are there?
Nitrous oxide (50% in O2 = entonox) - can be inhaled through labour and self administered Narcotics agents - pethidine, diamorphine Pudendal nerve block - sacral nerve roots 2,3,4 - 8-10ml of 1% lidocaine injection (used with perineal infiltration for instrumental delivery) Local anaesthesia (lidocaine) infiltrated into perinuem is used before episiotomy at time of delivery and before suturing vaginal tears
What regional anaesthesia options are there?
Epidural anaesthesia - anaesthetising pain fibres carried by T10-S5
Combined spinal epidural - gives quicker pain relief
Spinal anaesthesia - used for most LSCS in UK
Why should the woman be fully consented before regional anaesthesia?
Small complication rate
Can epidurals be regularly topped up?
Yes - a catheter is left in the epidural space
Epidurals can help lower BP in…
Pre-eclampsia
What complications can occur with epidurals?
Failure to site Patchy block Hypotension Dural puncture Post dural puncture headache Transient or permanent nerve damage Increased risk of operative vaginal delivery
What should be checked before doing an epidural?
Platelet count is >75x10^9
What space is the the epidural usually inserted between?
L3/4 space
What should be done once epidural inserted?
Monitor BP every 5 mins for 20 mins
Record block height and density
Continuous CTG fetal monitoring
Top ups required approx 2 hourly
Does an epidural or spinal take longer to establish?
Epidural
Describe spinal anaesthesia
Relatively easier to insert than epidurals
Produce a reliably dense block
Single injection
May wear off if procedure is prolonged > 2 hours
Can cause more profound hypotension compared with epidural
Following epidural insertion, what is commonly seen in fetus?
Fetal bradycardia in response to maternal hypotension
Almost always recovers with IV fluids
When is a combined spinal epidural used?
To cover a Caesarean section with the potential to take more time than usual e.g placenta praevia or previous difficult surgery
What side effects are there with narcotic agents?
Mother: drowsiness, nausea, vomiting
Baby: short term respiratory depression and drowsiness which may last several days
May interfere with breastfeeding
If given IM or IV should be given with anti emetic
What is the most commonly used narcotic agent?
Pethidine 50-150mg IM given with cyclizine 50mg IM
Why is the L3/4 space typically used?
Well below the termination of spinal cord (conus medullaris)
How is an epidural done?
Ask woman to sit down and lean forwards or lie on side with knees to chest
Injection of local anaesthesia go numb skin
A needle used to insert a fine plastic tube called an epidural catheter into epidural space
Needle then removed, leaving just catheter in spine
Pain relief medications then given through the catheter - takes 20-30mins to take full effect
What side effects are there with epidurals?
Low BP - can cause light headedness or nausea
Temporary loss of bladder control
Itchy skin
Headaches
Epidurals are linked to a longer…
Second stage labour
