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Pain Relief Measures Used in Labor

Pain Relief Measures Used in Labor. Theories of Pain. Gate control theory pain can be controlled by tactile stimulation and modified by activities controlled by CNS (backrub, effleurage, suggestion, distraction, and conditioning). Endorphins

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Pain Relief Measures Used in Labor

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  1. Pain Relief Measures Used in Labor

  2. Theories of Pain • Gate control theory • pain can be controlled by tactile stimulation and modified by activities controlled by CNS (backrub, effleurage, suggestion, distraction, and conditioning). • Endorphins • endogenous morphine-if endorphins are released pain will be decreased-relaxed environment and positive thoughts. Endorphin levels act on central and peripheral system to decrease pain.

  3. Sources of Pain • First Stage-cervical dilation causes visceral pain-contractions • Second Stage-perineal pressure on structures, stretching, burning (somatic pain) • Factors affecting response to pain • culture • fatigue/sleep deprivation-less pain tolerance and reserve • previous experience-coping mechanisms for pain past experiences • anxiety-mild good for focusing, excessive causes catecholamine secretion which increases stimuli to brain causing fear, muscle tension, increased discomfort

  4. Psychoprophylaxis • Lamaze-grew from Pavlov’s work on conditioning • Relaxation techniques relax all muscle groups • Breathing patterns • Effleurage- light stroking of the abdomen, thigh or chest • Water therapy buoyancy and warmth fosters relaxation • Web link to breathing patterns

  5. Psychoprophylaxis • Other Methods • Grantley Dick-Read-3 techniques-exercise, relaxation, breathing techniques • Bradley-husband coached childbirth-relaxed, quiet, slow breathing controlled • Hypnosis (hypno birthing) • Positioning-pillows, support • Transcutaneous Electrical Nerve Stimulation (TENS)-based on gate control theory

  6. Analgesia (IV, IM) • Goal: Pt. has maximum pain relief at minimal risk to mother and fetus. Pt. is conscious but sedated and retains full motor function.

  7. Systemic Analgesia • Narcotics-all narcotics may cause respiratory depression in mom &/or CNS depression in fetus • Meperidine HCL (Demerol) may be give IV or IM in 1st stage of labor • Fentanyl (Sublimaze)may be given IV or IM in 1st stage of labor • Mixed narcotic agonist-antagonists • Stadol may be give 0.5 mg -2mg IV or IM. 1st stage • Nubain 5-10 mg IV or IM in 1st stage of labor. Only until 4 cm without order

  8. Systemic Analgesia Cont’d • Analgesic Potentiators (ataractics). Do not decrease pain but decrease anxiety and apprehension and potentiate the action of narcotics • Phenothiazines-Phenergan, compazine, vistaril, used to promote relaxation, allay anxiety, control emesis, and potentiate narcotic effect. • Narcotic Antagonists: Narcan reverses the action of narcotics both adults and neonates. • Dose for infant= 0.01mg/kg IM, IV, SQ may be repeated • Dose for adult= 0.1-0.2 mg IV q 2-3 minutes prn

  9. Sedatives and Tranquilizers • Benzodiazepines • valium, versed-used to reduce anxiety, sedative /hypnotic (C-section) • Butyrophenones • inapsine, haldol-used to produce profound amnesia and post--op sedation • Barbituates • seconal, pentobarbital-used to promote relaxation and sleep in early or false labor.

  10. Nursing Care • Maternal Status • check BP, watch for decreased respirations, encourage rest b/t contractions. • Fetal status • note a decrease in beat to beat variability • Try to administer narcotic IV during the contraction over appropriate time frame. Why? • Labor Status • relaxation fosters dilation

  11. Anesthesia • A total loss of sensory capability, may be regional or centrally to brain (consciousness is lost); usually implies that one or more vital organ functions are under partial or total control of anesthesia provider. • Regional Blocks-differentiate site of insertion in each type

  12. Epidural Anesthesia • Epidural: • Advantages • mom alert and cooperative, only partial paralysis, gastric emptying delay, blood loss minimal, decrease effect on fetus • Disadvantages • maternal hypotension ☺, need for IV, numbness heaviness of legs, may make labor longer increase pushing.

  13. Epidural Anesthesia Note that the needle does NOT cross the dura mater

  14. Spinal Anesthesia • Spinal Block • Advantages • good pain control, alert and awake, no resp. effects • Disadvantages • marked hypotension,  cardiac output, spinal H/A, loss of motor function and sensory function • Complications-spinal H/A—constant H/A when HOB elevated, sx alleviated when lying flat. • Treatment-Blood patch, caffeine intake

  15. Spinal Anesthesia

  16. Nursing Care with Epidural Anesthesia • Careful hemodynamic monitoring • Assess BP q5 minutes at beginning of procedure and continue til 20minutes after insertion of catheter. Longer if BP is decreased. • Bolus with 1000ml of fluid, commonly Lactated Ringers solution, prior to beginning procedure. • Positioning • Client is asked to sit at the side of the bed. Have ct relax, drop shoulders, use relaxation breathing during contractions. • Help ct stay still and push lower back out towards the anesthesiologist

  17. Link for information on Blood Patch for post Spinal Headache

  18. Anesthesia cont’d • Pudendal Block numbs the nerves that run along vaginal canal • Advantages • alert, motor control, complete perineal anesthesia, no maternal hemodynamic changes • Disadvantages • lack pushing sensation, increase change of forceps or vacuum. • Local infiltration numbness of area for epis, used at time of delivery • Advantages • rapid anesthesia 10 min. • Disadvantages • none

  19. Pudendal Anesthesia

  20. Local Infiltration

  21. Anesthesia cont’d • Use of epidural and intrathecal narcotics • short-acting • Fentanyl or Sufenta-short term pain relief good for rapid laboring patients • long-acting • Morphine (Duramorph or Astromorph—long-acting)☺ • Risks to mother and common side effects —resp depression, decreased motor function, itching, dizziness. • Essential nursing assessments—assess respiratory status and sensorimotor status q 1hr X 24hr. • Interventions-Benadryl, Nubain for itching • Use of nitrous oxide http://midwife.org/ACNM/files/ACNMLibraryData/UPLOADFILENAME/000000000080/Nitrous_Oxide_12_09.pdf

  22. Anesthesia cont’d • General Anesthesia –emergencies only • IV anesthesia-NaPenthothal • Complications • fetal depression-fast delivery • uterine relaxation-increase bleeding due to relaxation • vomiting and aspiration-Bicitra 30 min before • Nursing Care • use of antacid (Bicitra) • Positioning mother-assist intubation

  23. Anesthesia cont’d • Types of anesthetics • Amides-Lidocaine, Mepivacaine, Bupivicaine (Marcaine): • more powerful and longer acting, placental transfer and affect on fetus • Esters-Procaine(novacaine), Nesacaine, Pontocaine, • metabolize quickly, placental transfer

  24. Whew that’s all!!!!

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