Obstetrics anesthesia and analgesia Dr Nawal Alsinani Analgesia

Obstetrics anesthesia and analgesia Dr. Nawal Alsinani

Analgesia : Loss of perception of pain. Anesthesia : Loss of ability to perceive touch – pain and other sensation.

General consideration 1 – two person to be consider. 2 - respiratory center of the infant is highly vulnerable to sedative and anesthetic. 3 – duration of administration. 4 – patient preparation.

Anatomy of pain 1 – pain in first stage of labour. L 1 – T 10 – T 11 – T 12. 2 – sensory pathways : - Uterine plexus. - Inferior hypo gastric plexus. - Midle and superior hypo gastric. - Lumbar and lower thoracic symptathetic chain

2 – pain in the 2 nd stage - branches of the pudendal nerve. - Conveyed along nerve roots S 2 -S 3 –S 4 - Other nerves as the ilioinguinal nerve – genitofemoral nerves.

Techniques of analgesia without the use of drugs * Psychoprophylaxis * hypnosis

Analgesic , amnestic and anesthetic agents * General comments and precautions : 1 - prepare patient psychologically. 2 - individualize the treatment of every patient. 3 - know the drugs. 4 - all systemic drugs cross the placenta. 5 - No drugs has selective maternal effects.

Pharmacologic aspects 1 - route of administration : - Oral , I. M , I. V. 2 - placental transfer.

Specific types of analgesic agents 1 - Inhalant agents : - Nitrous Oxide ( 50% N 2 O + 50% O 2 ) Good in 1 st stage of labor. 2 - Sedatives : * Produce drowsiness * Slow

3 - tranquilzers and amnestics : - Relieve apprehension Eg. Valium : If given early can cause Kernicterus. 4 - Narcotic Analgesics : - Used in 1 st stage of labor. Eg. Morphine : If given early can cause respiratory depression.

Regional Anesthesia - Lumbar Epidural Block. - Spinal Anesthesia. - Caudal Block. - Paracervical Block. - Pudendal Nerve Block.