Postpartum Analgesia: multimodal (Preston 4)

Question 1

What is multi-modal analgesia?

Answer 1

Combining various analgesics

Question 2

What are the different analgesics used in multimodal analgesia (6)?

Answer 2

Opioids, Acetaminophen, NSAIDS, LA, Anti-emetics, Anxiolytics

Question 3

Opioids for post delivery pain (5)?

Answer 3

• Morphine
• Hydromorphone (Dilaudid)
• Oxycodone (Oxycontin, oxycodone, oxycet)
• Codeine
  Meperidine (Demerol)

Question 4

PO Dose and onset of pp hydromorphone?

Answer 4

2-4 mg 20-30 mins

Question 5

What is the rationale for multi modal analgesia (2)?

Answer 5

(1) target the diff neurotransmitters involved in perception of pain (2) minimize the side effects of each agent (use synergistically and therefore use less of each)

Question 6

What are the mainstays for labour analgesia?

Answer 6

Opioids, NO, LA

Question 7

Mainstays for pp analgesia?

Answer 7

NSAIDS, acetaminophen, opioids, and nausea prevention

Question 8

Determinants of drug effect?

Answer 8

Lipid solubility, protein binding, pKA