PowerPoint Presentation Labour Analgesia.pptx

Gynaecological

1. WELCOME Dr. Aklima Akter Assistant Professor ( Gynae ) Sheikh Hasina Medical College, Tangail

2. Labour Analgesia The intensity of labour pain depends on the intensity and duration of uterine contractions, degree of dilatation of the cervix, distension of the perineal tissue, parity and pain threshold of the subject. The most distressing time during the whole labour is just prior to full dilatation of the cervix.

3. Labour analgesia The procedure should produce efficient relief of pain but should neither depress the respiration of the fetus nor depress the uterine activity causing prolonged labour . The drug must be non-toxic and safe for both the mother and the fetus.

4. Labour analgesia For the purpose of selecting a general analgesic drug, labour has been divided arbitrarily into two phases. The first phase corresponds upto 8 cm dilatation of the cervix in primi gravida and 6 cm in case of multipara. The second phase corresponds to dilatation of the cervix beyond the above limits upto delivery. The first phase is controlled by sedatives and analgesics and the second phase is controlled by inhalation agents. The idea is to avoid the risk of delivery of a depressed baby

5. Methods of pain relief Sedatives and analgesics Inhalation agents Regional analgesi Transcutaneous electric nerve stimulation(TENS) Psycho prophylaxis General anaesthesia for caesarian section

6. Sedatives and analgesic The following factors are important to control the dose of sedatives and analgesics The threshold of pain- The threshold of pain varies from patient to patient, so that each mother must be assessed individually. Primi gravida or multi para - The multiparous women need less analgesia due to added relaxation of the birth canal and rapid delivery. Maturity of the fetus- Minimal doses of drugs are indicated while the fetus is thought to be premature to avoid the risk of neonatal asphyxia.

7. Sedatives and analgesic Opioid analgesics : Pethidine : for a long time it has been used as an analgesic in labour . It has got strong sedative but less analgesic efficacy. Generally used in the first phase of labour . Initial dose is 1.5 mg/kg body wt I/M. Side Effects of pethidine : Nausea, vomiting and delayed gastric emptying, crosses the placenta and may cause neonatal respiratory depression.

8. Sedatives and analgesics Tranquilisers : Diazepam: It is well tolerated by the patient, does not produce vomiting and helps in the dilatation of the cervix but it is avoided during labour as it causes neonatal hypotonia and hyppothermia , should not be given in preterm labour Midazolam : Is more potent and neonatal side effects are less compared to Diazepam

9. Inhalation methods Nitrous oxide and air: Nitrous oxide has minimum effects on the fetus and does not interfere with uterine contraction. This agent is used in the second phase of labour . Premixed Nitrous Oxide and oxygen: Cylinder contain 50% nitrous oxide and 50% oxygen mixture. Popularly named as E ntonox . Trichloroethyline ( Trilene ): No longer used this days. Methoxyflurane , Isoflurane , Enflurane : Not widely used.

10. Regional Analgesia When complete relief of pain is needed throughout labour , epidural analgesia is the safest and simplest method for procuring it. Continuous Lumbar epidural block : A lumbar puncture is made between L2 and L3 with the epidural needle. A plastic catheter is passed through the epidural needle for continuous epidural analgesia. Repeated doses of 4 to 5ml of 0.5% Bupivacaine or 1% Lignocaine are used to maintain analgesia. Epidural analgesia, as a general rule should be given when labour i s well established.

11. Regional analgesia Maternal hydration should be adequate with Normal saline or Hartman’s solution infusion prior commencing the blockade. The patient’s BP, pulse and fetal heart rate should be recorded every 15 minutes interval following induction of analgesia and if any hypotension occurs should be treated immediately.

12. Regional analgesia 2. Caudal epidural analgesia 3. Para cervical nerve block : Following the usual antiseptic safe guards, a long needle(15 cm or more) is passed into the lateral fornix, at the 3 and 9 o’clock positions. 4 to 5 ml of 1% lignocaine with Adrenaline are injected at the site of the cervix and the procedure is repeated on the other side.

13. Regional analgesia 4 . Perineal infiltration : For episeotomy - A 10 ml syringe with a fine needle and about 8-10 ml of 1% lignocaine hydrochloride is used. 5 . Pudendal nerve block: It does not relief the pain of labour but affords perineal analgesia and relaxation. Pudendal nerve block is mostly used for Forceps and vaginal breech delivery. It is blocked by either the trans vaginal or trans perineal route.

14. Regional analgesia 6. Spinal anaesthesia - Brief or minimum spinal anaesthesia is safer than prolonged spinal anaesthesia . 1 ml of hyperbaric lignocaine(5%) injection is given into the sub arrachnoid space of the 3 rd or 4 th lumbar interspace.

15. Side effects Spinal anaesthesia : Hypotension due to blocking of sympathetic fibres leading to vasodilation and low cardiac output. Respiratory depression may occur Post spinal headache due to low or high CSF pressure and leakage of CSF Meningitis due to faulty asepsis. Transient or permanent paralysis Toxic reaction of local anaesthetic drugs Nausea and vomiting are not uncommon

16. Side effects General anaesthesia : Mother may have a full stomach raising the probability of aspiration A large number of drugs pass through the placental barrier and may depress the baby. Uterine contractility may be diminished by volatile anaesthetic agents like ether, halothane Hypoxia and hypercapnia may occur. Time interval from uterine incision to delivery is related directly to fetal acidosis and hypoxia Longer the exposure to general anaesthesia before delivery, the more depressed is the APGAR score.

17. Thanks to All 19.09.2019