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 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.
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
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
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
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.
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
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
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.
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
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
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.
Epidural Anesthesia
Note that the needle does NOT cross the dura mater
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
Spinal Anesthesia
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
Link for information on Blood Patch for post Spinal Headache
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
Pudendal Anesthesia
Local Infiltration
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
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
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
Whew that’s all!!!!
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