Obstetric Analgesia PDF

Anesthesia and Analgesia in Obstetrics

Obstetric Analgesia •

Non pharmacological method ( ps psycho ychoproph prophylaxis, ylaxis, Transcutaneous Electric Nerve Stimulation)

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Systemic opioid analgesia analgesi a

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Inhalational Inhalat ional agent (ent (entono onox) x)

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Analgesia for vaginal vaginal delivery (local infi infiltration, ltration, pudendal puden dal block, sad saddle dle block)

Patient Controlled Analgesia Regional analgesia (spinal, epidural, epidural, Combined Spinal Epidural E pidural analgesia) GA for LSCS

Commonly used sedatives/analgesics in labour Opioid: •

Pethi ethidin dine e (m (mos ostt com commo mon) n)

- Dose:50 Dose:50-100 -100mg mg IM/IV at start tart of active phase (cervix 4cm dilated) - Dela Delay yg gas astric tric emptying, emptying, aspiration aspiration-metoclopramide/ promethazine

- Respir espirato atory ry de depr press essio ion n in neon neonate ate-- 0.1m 0.1mg g /kg IV naloxone, bag and mask ventilation

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Fentanyl -1mcg/kg IM/slow IV/infusion

- Cr Cross oss place placenta nta but not affect affect APGAR APGAR score score - Onset: 2-3min(IV) 2-3min(IV),, 10min(IM); 10min(IM); last ffor or 3030-60min 60min

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Tramadol  – 1-2mg/kg

Onset:15min; last for 2-3hr

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Nalbuphine ine - 10mg IM/ IM/IV

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Morphine  – 10mg IM

Inhalational agents 50:50 mixture of oxygen and nitrous oxide •

(entonox) - Anal Analge gesi sicc a att su suba bana naes esth thet etic ic co conc nc., ., 5 5-6 -6 brea breath thss sufficient suffic ient to provide analgesia during a contraction

(not inter interfere fere uteri uterine ne contraction& APGAR score) - Thr Through ough de deman mand d valv valve ev via ia mouth mouthpie piece/ ce/ face mask & deliver a peak inspiratory inspiratory flow of of at least 25L/min; deep breath before contraction & stop when contraction over - If conc ↑ →persistent →persistent hyperventilation →decrease oxygen oxygen supp supply ly to ffetus etus (however gas elimination elim ination is fast, overall effect is smal small) l)