Pain Relief During Labor2013.ppt - Pain Management General...

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Pain Management
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General Concepts of Pain Management Pain of labor is subjective experience. Pain from cervical dilation enter spinal cord at T10, T11, T12 & L1. Pain from vaginal & perineal distention enter at S2, S3, & S4. Regional anesthesia blocks painful stimuli from uterus, cervix, vagina, & perineum to thalmic centers in brain. Examples include: Spinal, Lumbar Epidural, Pudendal block
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Concepts of Pudendal Block: Regional anesthesia blocks pudendal nerve w/local anesthetic. Safest method of perineal anesthesia for SVD, forceps delivery, episiotomy, & perineal repair. Does not alter maternal oxygenation, circulation or GI function. Does not effect UCs, may inhibit bearing down efforts during 2nd stage of labor. Does not depress newborn.
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Concepts of Epidural Anesthesia Regional produced by injecting local into epidural space (@ 2nd, 3rd, or 4th lumbar vertebra). Duramorph eases pain 1st 24 hrs post-op. (May decrease resps.) Generally initiated during active stage of labor. Major effect is decrease in BP r/t vasodilation from local anesthetic agents. No direct effect on fetus unless maternal hypotension occurs causing placental circulation compromise.
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Concepts of Epidural (cont’d) High conc. of opioid receptors along pain pathway in spinal cord., brainstem, & thalamus. Receptors highly sensitive to opioids; thus producing marked analgesia lasting hrs.
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