1. ANAESTHESIA & ANALGESIA INANAESTHESIA & ANALGESIA IN
OBSTETRICS & GYNAECOLOGYOBSTETRICS & GYNAECOLOGY
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2. INTRODUCTIONINTRODUCTION
 ENDEAVOURS TO ALLEVIATE PAIN OF LABOUR DATES FARENDEAVOURS TO ALLEVIATE PAIN OF LABOUR DATES FAR
BACK;BACK;
 -EARLY CHINESE : USED OPIATES-EARLY CHINESE : USED OPIATES
 -MIDDLE AGES : SELFADMINISTRATION OF ALCOHOLICS-MIDDLE AGES : SELFADMINISTRATION OF ALCOHOLICS
 -ETHER ; THE FIRST OBSTETRIC ANAESTHETIC, INTRODUSED-ETHER ; THE FIRST OBSTETRIC ANAESTHETIC, INTRODUSED
BY DR.J Y SIMPSON IN 1847BY DR.J Y SIMPSON IN 1847
 -CHLOROFORM ; IN 1853, WAS USED BY JOHN SNOW TO-CHLOROFORM ; IN 1853, WAS USED BY JOHN SNOW TO
DELIVER QUEEN VICTORIA IN THE BIRTH OF PRINCEDELIVER QUEEN VICTORIA IN THE BIRTH OF PRINCE
LEOPOLDLEOPOLD
 -NITROUS OXIDE ; WAS FIRST USED BY KLIKOWITSH IN 1881-NITROUS OXIDE ; WAS FIRST USED BY KLIKOWITSH IN 1881
 -SYSTEMIC ANALGESICS;IN 1902 COMBINATION OF-SYSTEMIC ANALGESICS;IN 1902 COMBINATION OF
MORPHINE & SCOPOLAMINE AND SINCE 1940 TILL TODAYMORPHINE & SCOPOLAMINE AND SINCE 1940 TILL TODAY
PETHIDINE IS USEDPETHIDINE IS USED
 -LOCAL ANAESTHETICS ; IN 1910 COCAINE WAS APPLED TO-LOCAL ANAESTHETICS ; IN 1910 COCAINE WAS APPLED TO
VAGINA AND VULVAVAGINA AND VULVA
 -SPINAL & EPIDURAL; WERE KNOWN SINCE 1928 AND 1940-SPINAL & EPIDURAL; WERE KNOWN SINCE 1928 AND 1940
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3. THE AIMS OF OBSTETRICTHE AIMS OF OBSTETRIC
ANALGESIA AREANALGESIA ARE
 (1) TO RELIEVE PAIN AND(1) TO RELIEVE PAIN AND
DISCOMFORT,DISCOMFORT,
 (2) WITHOUT PROLONGING LABOUR,(2) WITHOUT PROLONGING LABOUR,
 (3) WITHOUT SIGNIFICANT HAZARD TO(3) WITHOUT SIGNIFICANT HAZARD TO
THE MOTHER,THE MOTHER,
 (4) WITHOUT SIGNIFICANT HAZARD TO(4) WITHOUT SIGNIFICANT HAZARD TO
THE BABY.THE BABY.
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4. METHODS:METHODS:
 A] NON-PHARMACOLOGICALA] NON-PHARMACOLOGICAL::
 [1][1] PSYCHOPHYSICALPSYCHOPHYSICAL -- ANTENATAL PREPARATION-- ANTENATAL PREPARATION
 - EDUCATION- EDUCATION
 - DEVELOPMENT OF VARIOUS TECHNIQUES OF- DEVELOPMENT OF VARIOUS TECHNIQUES OF
RELAXATIONRELAXATION
 [2][2] HYPNOSISHYPNOSIS -- LIMITTED SUCCESS RATE( 25-60%) AND REQUIRE A-- LIMITTED SUCCESS RATE( 25-60%) AND REQUIRE A
GREAT DEAL OF TIME TO FULLFIL.GREAT DEAL OF TIME TO FULLFIL.
 [3][3] ACUPUNCTUREACUPUNCTURE -- LIMITTED EFFICACY FOR THE PAIN OF LABOUR-- LIMITTED EFFICACY FOR THE PAIN OF LABOUR
 [4][4] TRANSCUTANEOUS NERVE STIMULATION ( TNS )TRANSCUTANEOUS NERVE STIMULATION ( TNS ) -- APPLICATION-- APPLICATION
OF A VARIABLE ELECTRICAL STIMULUS TO THE SKINOF A VARIABLE ELECTRICAL STIMULUS TO THE SKIN
 IT IS MOST HELPFUL FOR BACHACHE. ITS SUCCESS IN LABOUR ISIT IS MOST HELPFUL FOR BACHACHE. ITS SUCCESS IN LABOUR IS
20 - 60%20 - 60%
 [5[5]] AUDIOANALGESIAAUDIOANALGESIA -- THE USE OF WHITE SOUND, MAY HELP !-- THE USE OF WHITE SOUND, MAY HELP !
 [6][6] ABDOMINAL DECOMPRESSIONABDOMINAL DECOMPRESSION -- HAS LITTLE PLACE IN MODERN-- HAS LITTLE PLACE IN MODERN
OBSTETRICS !OBSTETRICS !
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5.  B]B] INHALATION ANALGESIA :INHALATION ANALGESIA :
 [1][1] NITROUS OXIDENITROUS OXIDE ;MIXED WITH AIR IN THE;MIXED WITH AIR IN THE
MINNIT APPARATUS AND WITH OXYGENMINNIT APPARATUS AND WITH OXYGEN
{50 : 50} IN THE ENTONOX{50 : 50} IN THE ENTONOX
 [2][2] TRICHLORETHYLENETRICHLORETHYLENE ; ITS QUALITY OF; ITS QUALITY OF
ANAESTHESIA IS SIMILAR TO ENTONOX.ANAESTHESIA IS SIMILAR TO ENTONOX.
 [3][3] METHOXYFLURANEMETHOXYFLURANE ; IS SIMILAR TO THE; IS SIMILAR TO THE
A/M ,USED IN A MIXTURE OF 0.35 IN AIR INA/M ,USED IN A MIXTURE OF 0.35 IN AIR IN
CARDIFF INHALER.CARDIFF INHALER.
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6.  C]C] NARCOTIC ANALGESICSNARCOTIC ANALGESICS ::
 [1][1] PETHIDINEPETHIDINE ; I.M. 50-100MG WITH ONSET 10-15M; I.M. 50-100MG WITH ONSET 10-15M
LASTING 3-4HRS,MAY CAUSE;LASTING 3-4HRS,MAY CAUSE;
 ~MATERNAL VOMITING,NAUSEA AND~MATERNAL VOMITING,NAUSEA AND
POSSIBLE ADDICTIONPOSSIBLE ADDICTION
 ~PLACENTAL TRANSFER-- NEONATAL~PLACENTAL TRANSFER-- NEONATAL
DEPRESSANT FEEDING FUNCTIONDEPRESSANT FEEDING FUNCTION
 [2][2] PENTAZOCINEPENTAZOCINE; 50-60MG IM,LESS INCIDENCE OF; 50-60MG IM,LESS INCIDENCE OF
VOMITING.HAS A HALLUCINOGENIC SIDE EFFECTS.VOMITING.HAS A HALLUCINOGENIC SIDE EFFECTS.
 [3][3] MEPTAZINOLMEPTAZINOL; HAS LESS DEPRESSANT; HAS LESS DEPRESSANT
RESPIRATORY EFFECT.MORE VOMITING.RESPIRATORY EFFECT.MORE VOMITING.
 # REMEMBER NALAXONE AS AN OPIATE# REMEMBER NALAXONE AS AN OPIATE
ANTAGONIST = 40-200mG FOR THE NEONATEANTAGONIST = 40-200mG FOR THE NEONATE
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7.  D]D] CONDUCTION ANALGESIACONDUCTION ANALGESIA ::
 LOCAL ANAESTHESIALOCAL ANAESTHESIA ;;
 SIDE-EFFECTS: # MATERNAL=CNS-- DROWSINESS,SEVERESIDE-EFFECTS: # MATERNAL=CNS-- DROWSINESS,SEVERE
CONVULSIONSCONVULSIONS
 CVS-- BRADICARDIA, HYPERTENSION,CVS-- BRADICARDIA, HYPERTENSION,
CARDIAC ARREST(BLOCKING Na CHANNELS)CARDIAC ARREST(BLOCKING Na CHANNELS)
 # FETAL=ALL CROSS THE PLACENTA-- REDUCE# FETAL=ALL CROSS THE PLACENTA-- REDUCE
PLACENTAL CIRCULATION.PLACENTAL CIRCULATION.
 [1][1] INFILTRATION WITH LOCAL ANAESTHETICINFILTRATION WITH LOCAL ANAESTHETIC; MOST; MOST
COMMONLY USED.QUITE SAFE.COMMONLY USED.QUITE SAFE.
 [2][2] NERVE BLOCKS;NERVE BLOCKS; a) PUDENDAL BLOCK = USINGa) PUDENDAL BLOCK = USING
TRANSVAGINAL OR TRANSPERINEAL APPROACH.TRANSVAGINAL OR TRANSPERINEAL APPROACH.
b) PARACERVICAL BLOCK = USED IN FIRSTb) PARACERVICAL BLOCK = USED IN FIRST
ST.OF LABOUR.MAY CAUSE FETAL BRADICARDIA.ST.OF LABOUR.MAY CAUSE FETAL BRADICARDIA.
 [3][3] SPINAL(SUBARACHNOID) BLOCK;SPINAL(SUBARACHNOID) BLOCK; USED COMMONLY NOWUSED COMMONLY NOW
FOR CAESAREAN SECTION AND OTHER PELVICFOR CAESAREAN SECTION AND OTHER PELVIC
PROCEDURES.PROCEDURES.
 [4][4] EPIDURAL BLOCK(EXTRADURALEPIDURAL BLOCK(EXTRADURAL); FOR 1st ST. OF LABOUR); FOR 1st ST. OF LABOUR
NERVES TO BE BLOCKED T10-L1,FOR 2nd ST.-- S2-5.NERVES TO BE BLOCKED T10-L1,FOR 2nd ST.-- S2-5.
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9.  E]E] GENERAL ANAESTHESIA :GENERAL ANAESTHESIA :
 IMPORTANT ASPECTSIMPORTANT ASPECTS; G.A. IS STILL ASSOCIATED; G.A. IS STILL ASSOCIATED
WITH SIGNIFICANT MORBIDITY & MORTALITY DUEWITH SIGNIFICANT MORBIDITY & MORTALITY DUE
TO MANY FACTORS;TO MANY FACTORS;
 a) MATERNAL STARVATION, AS WELL ASa) MATERNAL STARVATION, AS WELL AS
PRESENCE OF STOMACH CONTENTS WILLPRESENCE OF STOMACH CONTENTS WILL
INCREASEINCREASE
 GASTRIC ACIDITY= THIS NEEDS ANTACIDS {MgGASTRIC ACIDITY= THIS NEEDS ANTACIDS {Mg
TRISILICATE ,Mg & ALUMINIUM HYDROXIDE,TRISILICATE ,Mg & ALUMINIUM HYDROXIDE,
SODIUMSODIUM
 CITRATE}. H2-RECEPTOR BLOCKERSCITRATE}. H2-RECEPTOR BLOCKERS
{CIMETIDINE & RANITIDINE} ARE VERY EFFECTIVE{CIMETIDINE & RANITIDINE} ARE VERY EFFECTIVE
ANTIACIDS.ANTIACIDS.
 b) AORTOCAVAL COMPRESSION; USE ALWAYSb) AORTOCAVAL COMPRESSION; USE ALWAYS
SLIGHT LEFT LATERAL TILT.SLIGHT LEFT LATERAL TILT.
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10.  E]E] GENERAL ANAESTHESIA :GENERAL ANAESTHESIA :
 IMPORTANT ASPECTSIMPORTANT ASPECTS; G.A. IS STILL ASSOCIATED; G.A. IS STILL ASSOCIATED
WITH SIGNIFICANT MORBIDITY & MORTALITY DUEWITH SIGNIFICANT MORBIDITY & MORTALITY DUE
TO MANY FACTORS;TO MANY FACTORS;
 a) MATERNAL STARVATION, AS WELL ASa) MATERNAL STARVATION, AS WELL AS
PRESENCE OF STOMACH CONTENTS WILLPRESENCE OF STOMACH CONTENTS WILL
INCREASEINCREASE
 GASTRIC ACIDITY= THIS NEEDS ANTACIDS {MgGASTRIC ACIDITY= THIS NEEDS ANTACIDS {Mg
TRISILICATE ,Mg & ALUMINIUM HYDROXIDE,TRISILICATE ,Mg & ALUMINIUM HYDROXIDE,
SODIUMSODIUM
 CITRATE}. H2-RECEPTOR BLOCKERSCITRATE}. H2-RECEPTOR BLOCKERS
{CIMETIDINE & RANITIDINE} ARE VERY EFFECTIVE{CIMETIDINE & RANITIDINE} ARE VERY EFFECTIVE
ANTIACIDS.ANTIACIDS.
 b) AORTOCAVAL COMPRESSION; USE ALWAYSb) AORTOCAVAL COMPRESSION; USE ALWAYS
SLIGHT LEFT LATERAL TILT.SLIGHT LEFT LATERAL TILT.
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