Anaesthesia during Labour

Adnan Akram Riga. Latvia

03.11.2009
Types of Anaesthesia used

1. Spinal Anaesthesia
2. Epidural Anaesthesia
3. General Anaesthesia
4. Pudendal block
5. Paracervical block
6. IV meperidine
7. IM morphine
1. Spinal Anaesthesia
Spinal anaesthesia also known as
subarachnoid anaesthesia is a form of
local or regional anaesthesia, which
involves injection of an anaesthetic drug
into the subarachnoid cerebrospinal fluid
space (CFS).
Positions (a). sitting position
Positions (b) lateral
It is given generally through a fine needle,
usually 3.5 inches (9 cm) long. For extremely
obese patients, some anaesthesiologists are
known to prefer spinal needles which are
seven inches (18 cm) long
A 25G choice needle is inserted into the introducer,
passing through the epidural space, dura, and
arachnoid to the sub arachnoid space stopping
when the presence of CSF is determined. CSF is
aspirated and mixing lines are identified as a
change in baricity and temperature as the local
anesthetic and CSF mix in the syringe. The dose is
slowly injected.
Agents used in Spinal Anaesthesia

Local Anaesthetics
Bupvicaine HCl
Ropavacaine HCl
Lignocaine HCl
Bupivacaine hydrochloride

Bupivacaine is a local anaesthetic that stabilises the

neuronal membrane and prevents the initiation and
transmission of nerve impulses. This drug is very
potent, four times that of lignocaine , and has a
rapid onset of anaesthesia with prolonged duration of
action. Bupivacaine is suitable for continuous epidural
blockade.
12-18mg, 90-120min (with epinephrine 150 mins)
 Ropivacaine Hydrochloride

Ropivacaine has both anaesthetic and analgesic

effects . At higher doses it produces surgical
anaesthesia with motor block, while at lower doses it
produces a sensory block, including analgesia, with
little motor block.

16-18mg, 90-120min
Lignocaine

Lignocaine has the same mechanism of anaesthetic

action to that of bupivacaine and ropivacaine.

75-100mg, 60-75min
Complications of Spinal Anaesthesia

1. Total Spinal Anaesthesia: hypotension, rapidly

increasing motor block, temporarily loss of breathing, loss of
consciousness, dilated pupils, and is preceded by respiratory
distress due to the blockade of some nerve cells.

2. High Block: nasal stiffness and difficulty breathing.

2. Epidural Anaesthesia
Epidural anaesthesia is a local anaesthetic infused into
the epidural (extradural) space.

The injection is usually made in the lumber region at

the L2/3 or L3/4 space.
Needle

An 18G Touhy needle is advanced through the

ligamentum flavum until a loss of resistance is felt
on attempted injection of air or saline.
Indications for Epidural Anaesthesia
Labour

Thoracic Surgery

Abdominal Surgery

Orthopaedic surgery
Agents Used in Epidural Anaesthesia
The patient is injected a combination of local anesthetics
and opioids . This combination works better than either type
of drug used alone. Common local anesthetics include
lidocaine, bupivacaine, and some derivates of
lopivacaine, chloroprocaine. Common opioids include
morphine, fentanyl, sufentanil, and pathedine
Spinal & Epidural Combination
3. General Anaesthesia
Indications

- emergency cesarean sections

- some types of forceps and other assisted deliveries.

Side effects of GA during labour

The new born is more effected, major sideeffects that

can be seen are

- breathing difficulties in newborn

4. Pudendal Block
Indications for Pudendal Block

Pudendal block is used primarily to relieve pain in the

second and third stages of labor for both normal
and instrumental (outlet) delivery.
Agents Used

Generally, a short-acting agent, such as lidocaine

1% or prilocaine 1%, produces very satisfactory
analgesia for 1.5-2.5 h. When analgesia of very rapid
onset is required, 2-chloroprocaine 2% can be
used. The duration of this agent will, however, be no
more than 1.5 h. A volume of 20 ml should not be
exceeded for a block of both nerves
Complications

1. maternal hematoma
2. systemic toxic reaction

3. trauma to the sciatic nerve

4. puncture of the rectum

5. Paracervical Block
Usage

Paracervical blockade may be used as a means of

reducing pain during the first stage of labour. Pain
associated with uterine contraction and cervical
stretching and dilatation is transmitted from these
structures on visceral afferents which accompany
sympathetic fibres
5 cm, 22-gauge or 25-gauge needle to inject the
lignocaine solution.

First 1 mL of 0.5% lignocaine solution is injected into

the anterior or posterior lip of the cervix which has
been exposed by the speculum.
 Complications

The proximity of uterine blood vessels in the vaginal

fornices creates maternal and fetal risks. Fetal
bradycardia occurs in 10-50% of cases.

Failure rate is 24 percent

Thankyou