LESSON PLAN

ON
ANALGESIA AND ANESTHESIA
NAME THE TEACHER : S.JEEVITHA

SUBJECT : OBSTETRIS AND GYNAECOLOGICALNURSING

TOPIC : ANALGESIA AND ANESTHESIA

TIME : 45 MINUTES

PLACE : III YEAR GNM

METHOD OF TEACHING : LECTURE CUM DISSCUSSION

AV AIDS : BLACK BOARD, PPT

LANGUAGE : ENGLISH

PREVIOUSKNOWLEDGE :

THE STUDENTS HAVING LITTLE KNOWLEDGE ABOUT

ANALGESIA AND ANESTHESIA
GENERAL OBJECTIVES:

At the end of the class the students will be able to understand the analgesia and anesthesia

SPECIFIC OBJECTIVES:

At the end of the class the students will be able to

• Introduction analgesia and anesthesia

• List the type of analgesia and anesthesia
• Explain the inhalation analgesia
• Explain the pharmacological analgesia
• List out the opioid drugs
• Describe about Role of nurses

TIME SPECIFIC CONTENT TEACHERS LEARNERS AV EVALUATION

OBJECTIVS ACTIVITY ACTIVITY AIDS
 INTRODUCTION B
Introduction • Child birth : most painful L
experiences the women will A
5mins analgesia and experience in their lifetime. C What is me
Explainig Listening
anesthesia • Several non-pharmacologic and and and K by analgesi
pharmacological techniques have been questioning answering. B
used to relieve the pain of childbirth . O and
• Analgesia and Anesthesia considerations A
are unique for each patient during the three R anesthesia?
stages of labor to address any acute pain D
management needs. &
GENERAL PRINCIPLE P
• woman’s request for labor pain P
List the type relief . T
5mins
• Formulate a suitable plan for pain
of analgesia relief is responsible of the unit.
Explainig Listening
and anesthesia • Identification of any of the risk
and and
factorsPlan should include strategies
questioning answering. What are th
to minimize the need for emergency
anesthesia in women type of
TYPES OF LABOURANALGESIA
AND ANAESTHESIA B Introduction
•Non-pharmacological analgesia L
•Pharmacological analgesia A analgesia an
•Regional anesthesia/analgesia C anesthesia?
•General anesthesia K
NON PHARMACOLOGICAL B
METHODS O
Hypnosis A
• Psychoanalgesia R
• Natural Childbirth D
• Psychoprophylaxis /Lamaze &
Explainig Listening
• Method P
and and
• Leboyer Technique P
questioning. answering.
• Acupuncture ,Acupressure & T
Aromatherapy
• Transcutaneous Electrical Nerve
Stimulation(Tens)
• Touch And Massage , Maternal
Movements,Birthing Ball And Positional
Changes
• Water Birthing B
HYPNOSIS L
• During labour, hypnosis A
(or‘hypnobirthing’) used to calm and C
comfort,make woman's receptivity to K
positive ‘suggestions’ & reduce the B
awareness of external stimuli. O
• Relieve pain & enhance feelings of Explainig Listening A
relaxation, safety and control. and and R
• It suppress the neural activity between the questioning answering. D
sensory cortex and the limbic system &
PSYCHO ANALGESIA/ NATURAL P
BIRTH P
• Dick-read originated this concept in the T
1940s.
• Fearless approach to labor in order to
minimize
pain.
• Dick-read is probably the first to advocate
using controlled breathing and relaxation
techniques during labor B
PSYCHOPROPHYLAXIS /LAMAZE L
METHOD A
•Popularized in1950s by French C
Explainig Listening
obstetrician Dr. Fernand lamaze K
and and
•Breathing together with relaxation reduces B
questioning answering
pain perception, enable women to give O
birth without drugs. A
•Lamaze mothers were able to give birth R
“awake and aware.” D
EBOYER TECHNIQUE &
 • In 1975 the French obstetrician Leboyer P
described “birth without violence. P
• He believed in delivering the baby in a T
silent semi-dark room and also avoiding
stimulation of the newborn immediately
after the delivery and avoid psychological
birth trauma of the neonate.
ACUPUNCTURE AND
ACUPRESSURE Explainig Listening
• Which involves the insertion of fine and and B
needles or application of pressure to questioning answering L
specific areas of the body. A
• It is widely believed that, these C
techniques work through the stimulation of K
touch fibres, which block pain impulses at B
the ‘pain gates’ within the spinal cord and O
the modification of endorphin release, A What are the
which alters pain perception. R pharmacologic
AROMATHERAPY D analgesia?
• Application of essential oils to the skin or &
inhalation of the scents of essential oils and P
their use in labour P
10mins is increasing in popularity. T
• It can increase the production of the
Explain the body's sedative, stimulant and relaxing Explainig Listening
pharmacologic neurotransmitters and and
al analgesia TRANSCUTANEOUS ELECTRICAL questioning answering
NERVE STIMULATION (TENS)
• It is the application of low‐voltage
electrical impulses to the lower back. In
labour, it is most often applied at B
the vertebral levels T10 to S2, where nerve L
pathways from the uterus, vagina and A
perineum enter the spinal cord. C
• Electrical pulses are believed to block the K
transmission of pain impulses within the B
spinal cord and to release O
of endorphins, which mediate pain A
perception R
BREATHING/RELAXATION D
TECHNIQUES AND TOUCH AND &
MASSAGE P
Explainig Listening P
Progressive muscle relaxation and focused and and
slow breathing and ‘traditional psycho‐ T
questioning answering
prophylactic course’, an alternative form of
relaxation training, are two relaxation
techniques used in labour.
WATER BIRTHING
 • Warm water immersion has a long history
of use in labour,used during any stage of
labour and for any duration B
of time. L
• Mechanism of pain relief is a A
physiological increase in uterine perfusion, C
which may promote K
endorphin and oxytocin release, thus B
increasing maternal satisfaction. O
• The water temperature should not exceed Explainig Listening A
37.5 and on hygiene measures for and and R
ANALGESIA IN OBSTETRICS questioning answering D
&
Which are t
ANALGESIA IS LOSS OF ABILITY
TO FEELPAIN WHILE STILL P inhalation
CONSCIOUS GOALS OF LABOUR P analgesia?
ANALGESIA : T
• Dramatically Reduce Pain Of Labor
• Should Allow ParturientToParticipate In
Birthing Experience
• Minimal Motor Block To Allow
Ambulation
5 mins • Minimal Effects On Fetus
• Minimal Effects On Progress Of Labor
PHARMACOLOGICAL B
Explain the ANALGESIA(SYSTEMIC NARCOTIC Listening L
inhalation ANALGESICS) Explainig and A
analgesia • Meperidine and answering C
• Hydrochloride/ Pethidine questioning K
• Nalbuphine B
• Butorphenol Tartrate O
• Morphine Sulphate A
• Fentany R
• PETHIDINE/MEPIRIDINE D
Dose :25 Mg Iv 50-100 Mg IM Q3- &
4h P
•Analgesic/Antispasmodic/Sedative/P P
roduce Euphoria T
• Begins To Act 30 Mts After IM & 5
Mts After IV
• Duration Of Action :2- 3hrs
• Slows Labour Contractions Listening
• Give 3 Hour Before Birth Explainig and
• Reduce Beat To Beat Variability Of and answering
FHS questioning
B
Contraindications: L
• Should not be used IV within 2 hrs A
and IM within 3 hrs of C
expected time of delivery of the baby, for K
fear of birth asphyxia. B
• preterm labour O
SIDE EFFECTS A
Maternal R
• Drowsiness D
• Dizziness &
• Confusion P
• Headache P
• Sedation T
• Nausea Listening
Explainig and
• Vomiting and
Fetal answering
questioning
• Respiratory depression
• Asphyxia
NALBUPHINE
• Dose:10-20mg Q3-6h 0.3- 3 Mg/Kg B
L
What me
Over 10-15 Mts by opio
• Effect On Mother:slows A
C drugs?
RR/Sedative/Analgesic
• Causes Respiratory Depression In K
Fetus B
BUTORPHANOL O
• Dose:1-2mg Im/Iv Q3-4h A
• Causes Slowing Of R
 Labour&Fetal Respiratory Listening D
• Depression Explainig and &
INTRA THECAL NORCOTICS: and answering P
MORPHINE SULPHATE questioning P
• Dose :0.2-1mg Intrathecally/5mg T
Epidurally
• Effective Analgesic /Cause Pruritus
• Slows Labour Contractions
10mins
• Cause Some Respiratory
Depression In Foetus
FENTANYL
List out the • Dose: 50-100 Microgram IM/25-50 B
opioid drugs Microgram IV L
• Cause Maternal Hypotension & A
Respiratory Depression C
• Slows Labor K
• Some Foetal Respiratory Depression Listening B
NON OPIOID ANALGESICS Explainig and O
• Sedative –Transquilizer Tolerated by and answering A
the patient questioning
R
Eg:Barbiturates,hydroxizine, D
benzodiazepines &
• Used For Sedation& Anxiolysis P
• Side Effects:Prolonged Depressive P
 Effect On Fetus Antidote for T
benzodiazepines : Flumazenil
INHALATIONAL ANALGESIA
• 50% Nitrous Oxide + 50% Oxygen
(Entonox )
• Quick onset 1-2 min.
• More effective for short term pain
relief B
• Nitrous Oxide 30-50% Listening L
• It Limits The Neuronal & Synaptic Explainig and A
Transmission Within The Central and answering C
Nervous System questioning
K
• Effect Within 20sec , Max Efficacy B
Within 45-50 Sec & O
• Administer Before Contraction A
Crosses placenta but eliminate efficiently R
no effect on neonate D
What are t
ANAESTHESIA IN LABOUR & role
• Regional analgesia :various nerve P nurses?
blocks have been developed over the P
years to provide pain relief during T
labor and delivery.
• They are correctly referred to as
regional analgesics.
 □ REGIONAL Listening
ANESTHESIA/ANALGESIA Explainig and
• Epidural and answering
• Spinal questioning
B
• Combined spinal epidural (cse) L
• Continuous spinal analgesia A
/patient controlled analgesia C
• Paracervical block K
Pudendal block B
PUDENDAL BLOCK O
Safe and Simple method of providing A
analgesia for spontaneous Vaginal delivery R
PROCEDURE :PUDENTAL BLOCK D
10mins • Insert needle ( with 3 ml of &
lidocaine)until it touches the P
sacrospinous ligament and till the P
resistance of the plunger decreases Listening T
Describe • Another 3 ml is injected into this Explainig and
about region. and answering
Role of nurses • Withdraw the needle and insert just questioning
above the ischial spine till mucosa
and the rest of 10 ml of solution is
deposited.
• Repeat on the other side. B
Within 3 to 4 minutes , the pudendal block L
will allow pinching of the lower vagina A
and posterior vulva bilaterally without C
pain K
COMPLICATIONS OF PUDENDAL B
BLOCK O
• Central nervous system toxicity A
• Hematoma formation R
• Rarely, severe infection may D
originate at the injection site. The Listening &
Explainig and
infection may spread posterior to the and P
hip joint, into the answering P
questioning
• gluteal musculature. T
CONTINUOUS SPINAL
ANAESTHESIA
It describes subarachnoid blockade
maintained by local anesthetics
administered through an Indwelling spinal
catheter
PARA CERVICAL BLOCK B
• Useful In Ist Stage of Labour L
• 15 Cm Long needle is passed into the A
lateral Fornix at 3 And 9 O Clock C
K
 position B
• 5-10 Ml Of Lignocaine with O
adrenaline are Injected at the site of A
the Cervix & Repeat at other side R
• Pain Relief 1-2 Hrs D
• Contra Indication :Placental &
Insufficiency P
• COMPLICATION: Fetal Brady P
Cardia T
EPIDURAL ANAESTHESIA
“Gold standard procedure for the pain
relief in obstetrics”
• Blocks spinal & sympathetic nerves
• May impede rotation of fetal head
due to relaxation of levatorani and
improve pushing ability B
DRUGS IN AN EPIDURAL L
• Epidural medications are a A
combination of local anesthetics C
(bupivacaine, levobupivacaine, or K
ropivacaine) and opioids (fentanyl, B
diamorphine, morphine, and O
sufentanil). A
• The opioid dosage used in epidural R
 is : D
• Opioid epidural &
• Sufentanil 25-50µg P
• Fentanyl 50-100µg P
• Diamorphine 2.0-3.0mg T
• Morphine 7.5-10mg
TECHNIQUE OF ADMINISTRATION
• Lie on side without flexing back
• 3-4 inch needle is inserted into L3-L4
interspace
• Poly ethylene catheter is inserted and
flush it. B
• warmness in legs after 5mts indicates L
correct catheter placement & effect A
lasts for 40 mts – 2hrs C
• Another dose of K
anaesthetic/continuous B
infusion/patient controlled analgesia O
• Remind her to void every 2 hours & A
Monitor BP R
BENEFITS OF EPIDURAL D
ANALGESIA &
• Administered at any stage of labor P
P
 and make mother alert & awake T
• Numb only the lower bodyin
case of a c-section.
Side effects: Hypo tension
• Prevention of hypotension:
• use fentanyl + bupivacaine 500 -
1000ml extra iv fluid;
• make her lie on side B
• Treatment: raise legs L
SPINAL ANAESTHESIA (spinal block, A
subarachnoid block, Intradural block and C
Intrathecal block) K
• It is a form of neuroaxial regional B
anaesthesia O
• It is a safe and effective form of A
anesthesia.The local anesthetic or R
opioid injected into the cerebrospinal D
fluid of the sub arachnoid space &
provides anesthesia, analgesia, and P
motor and sensory blockade. P
• The tip of the spinal needle is 9cm T
long and it has a small bevel
REGIONAL / SPINAL ANAESTHESIA
• Injects bupivocaine/tetracaine to
 block specific nerve
• Acts by blocking sodium &
potassium transport
• Effect on newborn flaccidity,
bradycardia, hypotension
• woman is awake
• do not depress uterine tone
GENERAL ANAESTHESIA
Is a medically induced coma with loss of
protective reflexes, resulting from the
administration of one or more general
anaesthetic agents.
PURPOSES
• Analgesia (loss of response to pain)
• Amnesia (loss of memory)
• Immobility (loss of motor reflexes)
• Hypnosis (unconsciousness)
Paralysis (skeletal muscle relaxation and
normal muscle relaxation
Techniques of GA
• START >3minutes O2
• Inj.Theopentone Sodium 200-250 Mg
(4MG/KG)
 • Followed by refrigerated
suxamethonium 100mg
• Apply cricoid pressure at the cricoid
cartilage of the neck
• Intubate with ET Tube and inflate the
cuff
• 50% N2O and 50% O2 and trace of
halothene
• Give muscle relaxant (vecuronium
bromide 4mg)
• After delivery > 75% N2O and
Administer Narcotics IV
ROLE OF NURSE IN ANALGESIA
AND ANESTHESIA IN LABOUR
• Monitor the woman's vital signs,
level of mobility, level of
consciousness, perception of pain and
level of pain relief.
• Monitor fetal status.
• Stop the continuous infusion if there
is a safety concern or the woman has
given birth.
• Initiate emergency therapeutic
measures if complications
 • Communicate clinical assessments
and changes in patient status check
sensation & movement of legs after
delivery .
• Do not allow to eat during labour
• Manipulate doses of
regional/intrathecal analgesia and
anesthesia delivered by continuous
infusion.
• Increase or decrease the rate of a
continuous infusion .Obtain
informed consent for analgesia and
anesthesia procedures

Summary
We discussed about the ,introduction, type of analgesia and anesthesia,role of nurses

Conclusion
At the end of the class the students will be able to understand the analgesia and anesthesia
REFERENCES
1. Dutta’s “ Text Book Of Obstetrics” 7th Edition,new Central Book Agency.
2. Eappen S, Robbins D. Nonpharmacological Means Of Pain Relief For Labor And
Delivery. Int Anesthesiol Clin. 2002;40(4):103–114.
3. Freeman RM, Macaulay AJ, Eve L, Chamberlain GV, Bhat AV. Randomised Trial Of
Self Hypnosis For Analgesia In Labour. Br Med J (Clin Res Ed). 1986;292(6521):657–
658.
4. Dick-read G. Childbirth Without Fear. New York: Harper & Row Publishers Inc; 1959 .