Analgesia and Anesthesia in labor. For B.Sc Nursing students. UNIT 11- PHARMACOTHERAPEUTICS IN OBSTETRICS

1. By:-
Angel Alina Varghese
Lecturer
Dept. of OBG(N)
GSCN, UDAIPUR
Analgesia and
Anesthesia during
Labor

2. Analgesia and Anesthesia in
Obstetrics
 Relief of pain during labor and delivery is
an essential part in good obstetric care.
 Choice of anesthesia depends upon
patient’s conditions and the associate
disorders.

3. Risk Factors for anesthesia are:-
 Short stature
 Short neck
 Marked obesity
 Severe pre-eclampsia
 Bleeding disorders
 Placenta previa
 Medical disorders (Cardiac, respiratory and
neurological diseases)

6. dose of sedatives and
analgesics
Pain Threshold
Parity
Maturity of the Fetus

7. Phases of Analgesia and
Anesthesia
Phases
First (upto
8cm/6cm)
• Sedative
and
Analgesics
Second
• Inhalation
Agents

8. Uterine
Contraction
Cervical
Dilatation
Pain

9. Intensity of pain depends upon
the
intensity and duration of uterine
contractions
 Degree of dilatation of cervix
 Distension of perineal tissue
 Parity and pain threshold of client

10. Methods of Pain Relief
 Psychoprophylaxis
 Sedatives and analgesics
 Inhalation agents
 Patient-controlled analgesia(PCA)
 Transcutaneous electric nerve stimulation
(TENS)
 Regional analgesia

11. OPIOID
ANALGESICS

12. LOCAL ANESTHETIC AGENTS
USED IN OBG
Drugs Usua
l
dose
s
Onset Duration
(Min)
Use in Obstetrics
Lignocain
e
7
mg
/ kg
Rapi
d
60-90
min
Local or pudendal
block also for
epidural or spinal
for cesarean
delivery
Bupivacai
ne
3
mg
/ kg
Slow 90-150
min
epidural or spinal
for cesarean
delivery

13. INHALATION
METHODS
Premixed Nitrous
Oxide and Oxygen

14. REGIONAL
ANESTHESIA
When complete relief of pain is
needed throughout labor, epidural
analgesia is the safest and
simplest method for procuring it.

15. ADVANTAGE :-
 Beneficence in cases like PIH, Preterm,
Twin Pregnancy, Breech Presentation.
 The client is awake and can enjoy the birth.
 Newborn APGAR score is good
 Lowered Risk of maternal aspiration
 Postoperative pain control is better.

16. -
 Second stage is prolonged by 15-30
minutes.
 Might lead to frequent need of
instrumental delivery like forceps or
ventouse.

17. PARA CERVICAL NERVE
BLOCK (Lignocaine)

18. PUDENDAL NERVE
BLOCK

19. SPINAL
ANESTHESIA

20. ADVANTAGE
Less fetal Hypoxia unless
there is Hypotension
Minimal blood loss

21. ES
 Hypotension
 Respiratory Depression
 Failed block, Chemical meningitis, epidural
abscess
 Post-spinal Headache
 Meningitis
 Transient or permanent paralysis
 Toxic reaction
 Nerve injury
 Nausea and vomiting
 Urinary retention

22. GENERAL
ANESTHESIA

23. INFILTERATION
ANALGESIA

24. PATIENT CONTROLLED
ANALGESIA

25. S
(Natural Childbirth)

26. TRANSCUTANEOUS ELECTRIC
NERVE STIMULATION