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Pain relief in labour

Pain relief in labour. Dr. L. Almaghur. ((... حملته أمه كرهاً ووضعته كرهاً ..)). objectives. To list the different types of pain relief used in labour. To understand the advantages, disadvantages and contraindications to each methods. Why is labour painful?. Ischemia of uterine muscles.

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Pain relief in labour

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  1. Pain relief in labour Dr. L. Almaghur

  2. ((...حملته أمه كرهاً ووضعته كرهاً..))

  3. objectives • To list the different types of pain relief used in labour. • To understand the advantages, disadvantages and contraindications to each methods.

  4. Why is labour painful? • Ischemia of uterine muscles. • Dilatation and strengthening of the cervix. • Stretching of the perineum in the second stage of labour.

  5. Who needs pain relief? respect the woman’s wish

  6. Panadol + NSAID Simple analgesia is usually ineffective in controlling labour pain X

  7. The ideal analgesic in labour • Good analgesia. • Easy to administer. • Safe to the mother and baby. • Easily reversible if necessary. • Does NOT interfere with uterine contractions. • Does NOT effect mobility.

  8. Types of pain relief in labour Non-pharmacological: • Relaxation. • TENS. • Hypnosis. • Acupuncture • Hydrotherapy. Pharmacological: • Opiates. • Inhalational. • Epidural.

  9. Relaxation “psycoprophylaxis” • Essential in all cases. • Antenatal classes to educate the mothers on what to expect. • Helps mothers to cope with pain and satisfaction with pain relief. • Carries no risk to the mother and fetus.

  10. Transcutaneous nerve stimulation(TENS)

  11. Low grade electronic waves to nerves supplying the uterus via skin electrode. • Provides good pain relief to 25% of patients. • Not available in our hospital. • Carries no risk to the mother and fetus.

  12. Hypnosis and acupuncture • Reported to be successful. • Needs special skill and preparation. • Carries no risk to the mother or fetus. • ??? Placebo effect • Does this matter????

  13. opiates • Pethidine and diamorphine are the commonly used drugs. • Given inter-muscular or intravenous • repeated when necessary.

  14. Advantages: • Offers good pain relief for most patients. • Short duration of action.

  15. Disadvantage: • Nausea and vomiting. (antiemetic) • Can cross BPB respiratory depression in the new born. (Nalaxone)

  16. Inhalational anesthesia • The commonest is nitrous oxide. • Self administered to the patient via face mask. • Given in a 50-50 mixture with oxygen (Entanox).

  17. Advantages • Provides analgesia varying from good to ineffective. • Under control of the patient. • Minimal adverse effects to mother and fetus.

  18. Disadvantage: • not adequate for second stage, instrumental delivery, suturing of perineum or manual removal of placenta. • Light headedness and nausea. • Not suitable for prolonged use.

  19. Epidural anesthesia الولادة بدون ألم

  20. Plastic catheter introduced into the epidural space. • Catheter is left in and the analgesia is given continuously. • Bupivican and Fentanyl

  21. Advantages: • The most effective pain relief. • The absence of pain allows enjoyment and control of labour. • Reduces maternal fatigue and anxiety. • Ideal in high risk pregnancies e.g. breech, MP, and PET.

  22. Disadvantage: • Restriction of movement during labour. • Requires CTG. • Requires resident anesthesia, cardio-respiratory facilities and one to one care. • ?increase rate of instrumental delivery. • Beware of urine retention.

  23. Complications: • Failure 3%. • Hypotension. • Epidural tap (headache) • ? Back pain. • Paralysis !!!!!!!!!.

  24. Analgesia used in second stage and third stage. • Nerve blocks. • Spinal anesthesia. • General anesthesia.

  25. Pudendal block • Performed by the obstetrician. • Used for outlet forceps and vacuum delivery.

  26. Spinal anesthesia Can be used for … • Instrumental delivery. • Manual removal of placenta. • Repair of third degree tear.

  27. Difference between epidural and spinal • Site. • Onset. • Duration.

  28. Contraindications to spinal or epidural anesthesia • Maternal refusal. • Hypovolemia. • Sever back deformities, • Local infection. • Coagulation disorders.

  29. General anesthesia • Manual removal of placenta. • Third degree tear

  30. summary • Labour is a painful experience. • Pharmacological and non-pharmacological method are used for pain relief. • Each method had its advantage and disadvantage and the choice of method depends on the stage of labour and maternal preference.

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