analgesia and a in labour

8/8/2019 Analgesia and a in Labour

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ANALGESIA AND

ANAESTHESA IN

LABOUR

PRESENTED BY:

JONES MARINA N V,FIRST YEAR M.SC

NURSING,

SRM COLLEGE OFNURSING.


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NERVE SUPPLY OF GENITAL

TRACT

:

2

.

2

2, 3


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:

2

- 11 12

.

2

.

2 &

2,3 4

.

2

.


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NERVOUS CONTROL OF

UTERIE ACTIVITY2

,

.


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HORMONAL CONTROL

2

.2 -

.

2 -

. .

2

.


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The intensity of labour pain depends on,

- the intensity & duration of

uterine contraction.- degree of dilatation of cervix.

- distention of perineal tissue.

- parity & pain threshold of thesubject.


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Sedatives and analgesics Inhalation methods

Transcutaneous electric nerve stimulation(TENS) Patient controlled anesthesia (PCA) Psycho prophylaxis

Hypnosis Regional anesthesia


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&

Factors: The threshold of pain

Primigravidae or multipara

Maturity of fetus

Phases:

First phase Second phase


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Pethedine: It is strong sedative but less analgesic

efficiency. Generally used in first stage of labour &

indicated when the discomfort of labourmerges into regular, frequent and painful

contractions. Dose 100mg (1.5mg/kg body wt)


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Cont

Meitazinol: Analgesic & sedative

Causes less respiratory depression to newborn

Pentazocin:

Sedative

30-40mg IM

Causes respiratory depression


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Diazepam:

Sedative and analgesic

5-10mg IV

Facilitate dilatation of cervix

Midazolam:

Anxiolytic drug Dose-0.05mg/kg body wt


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1. Nitrous oxide & air

2. Premixed nitrousoxide & oxygen

3. Trichloroethylene

(trilene)4. Methoxyflurane,

isoflurane,

enflurane


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() Narcotics are

administered by the

mother herself from apump at continuous orintermittent demandrate through

intravenous route. Drugs commonly used

are- pethedine,meperidine, fentanyl.


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Electrodes are placed at

the levels of T10 L1 and

S2- S4. Current strength can be

adjusted according to pain.

It works by inhibiting

transmitter releasethrough inter neuron level.


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when complete pain relief is neededthroughout labour regional anesthesiais preferred.

Continuous lumbar epidural block Caudal epidural analgesia Para cervical nerve block Perineal infiltration

Pudendal nerve block Transvaginal route Spinal anesthesia


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CONTINUOUS LUMBAR

EPIDURAL BLOCK A lumbar puncture is

made between L2 & L3.

When the epidural space

is ensured ,a plastic

catheter is passedthrough the epidural

needle for continuous

epidural analgesia.

Repeated doses of 4 to 5mi of 0.5% bupivacaine or

1% lignocaine are used to

maintain analgesia.


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CAUDAL EPIDURAL

ANALGESIA With the patient on left

lateral position and afterfull aseptic precaution sthe sacral hiatus isidentified.

A malleable needle ispushed through it, firstpiercing the skin and thesacro coccygeal ligamentat right angle anddepressing that needletowards natal cleft sothat the needle lies at anangle of 40 degree to theskin.

Then it advanced into

sacral canal.


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Cont..

The stylet withdrawn and an

aspiration test was done to ensurethat the Dura or vein is not punctured.

Epidural catheter is then passed

through the needle and the needle isthen withdrawn.

16ml to 20ml of 1% lignocane is

passed and relief of pain becomes

established with in 10 20 min.

Bupivacaine (0.5%) can be used for

prolonged analgesia.


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PARACERVICAL NERVE

BLOCK A long needle of 15cm or

more is passed through

the lateral fornix at thethree and nine o clock

positions.

4 5 ml of 1% lignocaine

with adrenaline areinjected at the site of

cervix and the procedure

is repeated on other side.


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PERINEAL

INFILTRATION

FOR EPISIOTOMY:

Perineum on the proposed

site is infiltrated in a fan-

wise manner, starting fromthe middle of fourchette.

Each time before infiltration

aspiration to exclude blood

is mandatory.

Episiotomy is to be done 2.5

min following infiltration.


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FOR OUTLET FORCEPSOR VENTOUSE:

The needle justposterior to theinteroitus.

About 10ml of thesolution is infiltrated in

the fanwise manner onboth sides of midline.

The needle is thendirected anteriorlyalong each side of the

vulva as for as theanterior third to blockthe genito femoral andilio-inguinal nerve.


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PUDENDAL NERVE

BLOCK Pudendal nerve block is

mostly used for forcepsand vaginal breechdelivery.

Simultaneous perinealand vulval infiltration isneeded to block theperineal branch of the

posterior cutaneousnerve of the thigh andthe labial branches ofilio inguinal and genitofemoral nerves.


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TRANSVAGINAL ROUTE:

The index and middle

finger of the two hands

are introduced into thevagina the finger tips

are placed on the tip of

the ischial spine of one

side.

The needle is passed

along the groove of the

fingers and guided to

pierce the vaginal wall

on the apex of ischialspine and thereafter to

push little to pierce

the sacro spinus

ligament just above the

ischial spine tip.


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SPINAL ANAESTHESIA

Spinal anesthesia can

be obtained by injecting

1ml of hyperbaric

lignocaine 3% into the

subarchnoid space of

third or fourth lumbar

inter space with thepatient lying on her side

with a slight head uplift.


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GENERAL ANAESTHESIA

FOR CAESARIAN SECTION Induction of anesthesia is

done with the injection of

thiopentone sodium 200-

250mg (4mg/kg) as a 2.5%

solution IV followed by

refrigerated

suxamethonium 100mg.

The patient is intubated

with a cuffed endotracheal

tube with cuff inflated. Anesthesia is maintained

with 50% nitrous oxide,50%

oxygen and a trace 0.5% of

halothane.


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analgesia and a in labour

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