Upload
jonesnv
View
219
Download
0
Embed Size (px)
Citation preview
8/8/2019 Analgesia and a in Labour
1/27
ANALGESIA AND
ANAESTHESA IN
LABOUR
PRESENTED BY:
JONES MARINA N V,FIRST YEAR M.SC
NURSING,
SRM COLLEGE OFNURSING.
8/8/2019 Analgesia and a in Labour
2/27
NERVE SUPPLY OF GENITAL
TRACT
:
2
.
2
2, 3
8/8/2019 Analgesia and a in Labour
3/27
:
2
- 11 12
.
2
.
2 &
2,3 4
.
2
.
8/8/2019 Analgesia and a in Labour
4/27
NERVOUS CONTROL OF
UTERIE ACTIVITY2
,
.
8/8/2019 Analgesia and a in Labour
5/27
HORMONAL CONTROL
2
.2 -
.
2 -
. .
2
.
8/8/2019 Analgesia and a in Labour
6/27
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.
8/8/2019 Analgesia and a in Labour
7/27
Sedatives and analgesics Inhalation methods
Transcutaneous electric nerve stimulation(TENS) Patient controlled anesthesia (PCA) Psycho prophylaxis
Hypnosis Regional anesthesia
8/8/2019 Analgesia and a in Labour
8/27
&
Factors: The threshold of pain
Primigravidae or multipara
Maturity of fetus
Phases:
First phase Second phase
8/8/2019 Analgesia and a in Labour
9/27
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)
8/8/2019 Analgesia and a in Labour
10/27
Cont
Meitazinol: Analgesic & sedative
Causes less respiratory depression to newborn
Pentazocin:
Sedative
30-40mg IM
Causes respiratory depression
8/8/2019 Analgesia and a in Labour
11/27
Diazepam:
Sedative and analgesic
5-10mg IV
Facilitate dilatation of cervix
Midazolam:
Anxiolytic drug Dose-0.05mg/kg body wt
8/8/2019 Analgesia and a in Labour
12/27
1. Nitrous oxide & air
2. Premixed nitrousoxide & oxygen
3. Trichloroethylene
(trilene)4. Methoxyflurane,
isoflurane,
enflurane
8/8/2019 Analgesia and a in Labour
13/27
() Narcotics are
administered by the
mother herself from apump at continuous orintermittent demandrate through
intravenous route. Drugs commonly used
are- pethedine,meperidine, fentanyl.
8/8/2019 Analgesia and a in Labour
14/27
8/8/2019 Analgesia and a in Labour
15/27
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.
8/8/2019 Analgesia and a in Labour
16/27
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
8/8/2019 Analgesia and a in Labour
17/27
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.
8/8/2019 Analgesia and a in Labour
18/27
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.
8/8/2019 Analgesia and a in Labour
19/27
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.
8/8/2019 Analgesia and a in Labour
20/27
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.
8/8/2019 Analgesia and a in Labour
21/27
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.
8/8/2019 Analgesia and a in Labour
22/27
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.
8/8/2019 Analgesia and a in Labour
23/27
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.
8/8/2019 Analgesia and a in Labour
24/27
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.
8/8/2019 Analgesia and a in Labour
25/27
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.
8/8/2019 Analgesia and a in Labour
26/27
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.
8/8/2019 Analgesia and a in Labour
27/27