pain relief in labour1

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nursing symposiummay 10,2010


  • 1.Pain Relief in Labour
    Consultant Anesthetist, Lead Pain Team
    Security Forces Hospital, Riyadh

2. Aim
Is how we can achieve better management of labour pain.
3. Objectives
Why do we give analgesia for child birth?
Humanitarian reason.
Economic benefit.
Medical reasons.
4. Medical Effects of Labour Pain
5. Background
It is only in the last 100 years that effective methods of pain relief have become available.
Queen Victoria was given chloroform by John Snow for the birth of her eightchildand this did much topopularize the use of pain relief in labour
6. Nowadays most women who deliver in modern obstetric units request some kind of pharmaco- logical pain relief.
Epidural analgesia is the gold standardin obstetric analgesia.
If an epidural is contraindicated or a woman dose not wish to have epidural, other methods can be used.
7. Entonox (50% Nitrous oxide + 50% Oxygen), Isonox (50% Nitrous oxide + 50% O2 + 0.2% Isoflurane).
IV PCA Remifentanil.
Parenteral opioids, Morphine, Pethedine, Fentanyl.
8. Adverse Effects of Parenteral Opioids
9. The Ideal Analgesic for Labour
10. Pain pathway in LabourThe afferent nerve of the uterusand cervix is via A delta and C fibers, that accompany thethoraco lumbar and sacral dorsal sympathetic chains.- Pain in first stage mediated through (T10 - L1 ).- In the second stage mediated through (S2 S4 ).
12. Pharmacological Treatments of Pain
13. History of Epidural (Current therapy in pain, HowardSmith, 2009)
First description of Ep. Analgesia dates back toLeonard J. Corning, a neurologist who in 1895 inadvertently injected cocaine in the Epidural space.
Since 1900, Epidural analgesia was being used to treat the pain of child birth.
14. In 1931 a continuous technique was described by Italian surgeon, A.M. Dogliotti. He was the first to describe the loss of resistance technique.
Philip Bromage published the first
text book on Epidural anesthesia
in 1978.
Bromage introduced the administration of epidural opioids for post operative analgesia in 1980.
1988:Introduction of PCA with Epidural by many anesthetists, allover the world.
15. Absolute Contraindications of Epidural
Patient refusal.
Blood Coagulopathy
Infection at the site of injection
Sever hypovolemia
Fixed cardiac out put
- Sever aortic stenosis
- Sever mitral stenosis
- Hypertrophic obstructive cardiomyopathy
In pregnancy
16. Relative Contraindications of Epidural
Systemic sepsis.
Uncooperative patient.
Preexisting neurological deficits,
e.g. demyelinating disease, peripheral neuropathy
Sever spinal deformity.
Avoid in pregnancy
17. The Failing epidural
18. Complication of Epidural
Nausea and vomiting.
19. Loss of motor power
Dural tap.
(post dural puncture headache)
20. 21. Combined Spinal Epidural (CSE) Analgesia

  • In 1993, anaesthetists in Queen CharlottesHospital in London described the CSE technique.

22. Touhy Needle is advanced in the lumber region. 23. Then 25 27 gauge, 120 mm-long pencil point spinal needle. 24. 1 ml of 0.25% Bupivacaine + 25 Micgr Fentanyl injected intrathecally. 25. Epidural bolus 15 mls 0.1% Bupivacaine + 2 Micgr/ml Fentanyl without test dose.