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!!!!