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2. Analgesia and Anesthesia. Session Objectives. To describe the principles of pain relief in emergency obstetric careTo describe different methods of pain relief in emergency obstetric care. 3. Analgesia and Anesthesia. Basic Requirements of Pain Relief. Supportive attention from staff before, during and after procedure to reduce anxietyMethod of pain relief that is:Appropriate for procedureAdequate for pain reliefSafe for woman (and baby)Skill and expertise of provider in using instruments gently and minimizing tissue damage .
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1. Analgesia and Anesthesia in Emergency Obstetric Care Managing Complications in Pregnancy and Childbirth These presentation graphics are based on the guide Managing Complications in Pregnancy and Childbirth: A guide for midwives and doctors (2000) by the World Health Organization.
These presentation graphics are based on the guide Managing Complications in Pregnancy and Childbirth: A guide for midwives and doctors (2000) by the World Health Organization.
2. 2 Analgesia and Anesthesia Session Objectives To describe the principles of pain relief in emergency obstetric care
To describe different methods of pain relief in emergency obstetric care
3. 3 Analgesia and Anesthesia Basic Requirements of Pain Relief Supportive attention from staff before, during and after procedure to reduce anxiety
Method of pain relief that is:
Appropriate for procedure
Adequate for pain relief
Safe for woman (and baby)
Skill and expertise of provider in using instruments gently and minimizing tissue damage
4. 4 Analgesia and Anesthesia Pain Relief in Labor Non-pharmacological methods of pain relief include:
Support from birth companion
Encouragement, compassion and support from provider
Ambulation and change of position
Back massage
Breathing techniques
Warm showers and baths
5. 5 Analgesia and Anesthesia Pain Relief in Labor (continued) If non-pharmacological methods of pain relief are not adequate:
Give:
Pethidine 1 mg/kg body weight (maximum dose 100 mg) IM or IV slowly OR
Morphine 0.1 mg/kg body weight IM
Give drug every 4 hours as needed
Give promethazine 25 mg IM or IV if vomiting occurs
6. 6 Analgesia and Anesthesia Local Anesthesia Blocks sensory nerves
Commonly used preparation is 0.5% with or without adrenaline
Addition of adrenaline reduces absorption and prolongs action
Premedication with pethidine and diazepam may be required for longer procedures
7. 7 Analgesia and Anesthesia Local Anesthesia (continued) Because the woman will be awake during the procedure:
Counsel her before the procedure to increase cooperation and reduce fears
Tell her what you are doing at each step of the procedure
Wait until the anesthetic has taken full effect before performing procedure
8. 8 Analgesia and Anesthesia Local Anesthesia (continued) Prevent complications of local anesthesia by:
Using dilute solutions (0.5% preferred)
Adding adrenaline when more than 40 mL will be used (e.g., cesarean section)
Using lowest effective dose
Not exceeding maximum dose
Without adrenaline 4 mg/kg body weight
With adrenaline 7 mg/kg body weight
Injecting slowly
Avoiding IV injection
9. 9 Analgesia and Anesthesia Nerve Blocks Target specific nerves to anesthetize a region of the body
Paracervical block can be used for dilatation and curettage and manual vacuum aspiration
Pudendal block can be used for instrumental delivery, breech delivery, episiotomy, repair of perineal tears, craniotomy/ craniocentesis
10. 10 Analgesia and Anesthesia Spinal (Subarachnoid) Anesthesia
Can be used for cesarean section, laparotomy, repair of extensive perineal tears, manual removal of placenta
Pre-load woman with 5001,000 mL IV fluids to avoid hypotension
Ensure sterile technique
Use finest needle available
Keep the woman flat on her back for at least 6 hours after procedure to prevent post-spinal headache When oxygen is available, it is also important to pre-oxygenate the woman before administering spinal anesthesia.When oxygen is available, it is also important to pre-oxygenate the woman before administering spinal anesthesia.
11. 11 Analgesia and Anesthesia Ketamine Ketamine is a general anesthetic
Can be used for any relatively short procedure where muscle relaxation is not required
AVOID ketamine in women with hypertension, pre-eclampsia, eclampsia or heart disease
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12. 12 Analgesia and Anesthesia Ketamine (continued) Usual dose:
610 mg/kg body weight IM OR
2 mg/kg body weight IV slowly over 2 minutes
When used alone, ketamine can cause unpleasant hallucinations
For ketamine infusion, premedicate with:
Atropine sulfate 0.6 mg IM 30 minutes before surgery AND
Diazepam (for cesarean section, give after the newborn is delivered)
13. 13 Analgesia and Anesthesia Postoperative Analgesia Good postoperative pain control regimens include:
Paracetamol 500 mg by mouth as needed
Pethidine 1 mg/kg body weight IM or IV slowly
Morphine 0.1 mg/kg body weight IM
Repeat every 4 hours as needed
Give Promethazine 25 mg IM or IV every 4 hours if vomiting occurs