Obstetric Anesthesia

and Analgesia
By: Edderlyn D. Lamarca
Saint John Colleges
 Analgesia
reduces or decreases awareness of
pain

 Anesthesia
causes partial or complete loss of
sensation
 Pain During Labor and Delivery
Pain during labor is caused primarily by
uterine muscle contractions and somewhat
by pressure on the cervix. This pain
manifests itself as cramping in the
abdomen, groin, and back, as well as a
tired, achy feeling all over. Some women
experience pain in their sides or thighs as
well.
I. Analgesics (Narcotic)
Narcotics may decrease the progress of
labor by reducing the force or rate of
contractions ( this is dose dependant as well
as dependant on the timing of the doses
Biggest effect is in the latent phase

In the active phase of labor narcotics my

speed up the progress of labor by
decreasing anxiety and decreasing
catecholamines.
 Meperidine (Demerol)
Most common analgesic in North America
and Europe
IM up to 100mg-onset 40-50 min

IV up to 50mg-onset5-10 min

Quick placental transfer

½ life 3 hours in mother (up to23 in fetus)

Metabolized to normeperidine
 Morphine
IV 20min onset time

Last 4-6hours
Very high likelihood on neonatal depression

Not used for pain in Labor

Used for sedation in latent phase

10-15mg IM
 Pentazocine (Talwin)
No advantage over other narcotics

Respiratory depression

Weak opiate antagonist, strong opiate

agonist
 Butorphanol (Stadol)
Synthetic analgesic like pentazocine (mixed
agonist/antagonist
5 times more potent than morphine (40X
more than Demerol)
Dose 1-2 mg

IM 10min onset, IV 1-2min onset

Duration 2-4 hours

 Butorphanol cont.
Metabolites are inactive

Less nausea and vomiting

Causes drowsiness

Don’t give after Demerol

 Alphaprodine (Nisentil)
Rapid onset of action 5-10 min sub Q, 1-2min IV
(IM absorbtion is unpredictable)
Short duration 1-2 hours

Repeated doses result in long duration of action

because it is accumulated in tissue and slowly
released
Maternal respiratory depression is common

Dose 10-20mg IV

Dose 30mg sub Q

 Fentanyl (Sublimaze)
Synthetic opoid 1000 times more potent than
meperidine
Rapid onset

Brief duration

Repeated doses result in drug accumulation and

long duration of action
Dose 50-100micrograms IV

Not used in labor

Causes sudden and profound respiratory

depression
 II. Anesthetic
Anesthetic refers to a technique or
medication that partially or completely
eliminates sensation or feeling
 2 types of nerve-blocking
anesthetics
Local anesthetics block sensory nerve
pathways at the organ level.

Regional anesthetics block sensory nerve

pathways along the course of tissues.
Level of anesthesia for cesarean
and vaginal delivery.
 NERVE-BLOCKING
ANESTHETICS USED IN
OBSTETRICS
 a. Local Anesthetics
produces anesthesia only in the area where
injected. It is used in the superficial nerves of the
perineum to make or repair episiotomy. 
Lidocaine 1percent drug normally used and is
short acting.
Local anesthetics are used frequently for
delivery.
 b. Regional anesthetics
Regional anesthetics include:
 paracervical block

 pudendal block

 saddle block (low spinal)

 caudal or lumbar epidural.

 • Paracervical block.
Paracervical is an injection of a dilute local
anesthetic into the paracervical nerve endings
through the vagina.
relief within five minutes after administration
and is good for about 45 to 60 minutes.
The patient doesn't feel the cervical pain related
to the uterine contractions.
Paracervical block
 • Pudendal block
Pudendal block is an injection of local
anesthetic on both sides of the vagina. It is
administered just prior to delivery. It numbs the
perineal area, vulva, and the vagina. It is used
frequently in labor and delivery in combination
with local anesthesia.
Pudental Block

Bilateral blockage of the pudendal

nerve will result in complete
anesthesia over the perineum
 •Saddle block (low spinal)
•is an injection of anesthetic agent
directly into the spinal canal below the
spinal column to cause loss of sensation
below the injection site.
•patient has to sit up on the table with
legs crossed or hanging over the side.
•It numbs the abdominal and pelvic areas
below the umbilicus to include the
perineum, legs, and feet.
 Cont. Saddle block
•The patient will usually feel
contractions.
•Side Effects are severe maternal
hypotension due to vasodilation and
decreased oxygen to the fetus as a result
of hypotension.
Saddle block
 •Caudal or lumbal
epidural
•is an injection of anesthetic agent in the
peridural space through the sacral hiatus.
•is an injection of anesthetic agent on top
of the dura space through the 3rd and 4th
or 5th lumbar space.
•It numbs the abdominal and pelvic areas
below the umbilicus to the midthigh.
 Cont. Caudal
•The patient doesn't feel contractions or
perineal stretching.
•The urge to push may be blocked,
although the ability is still present.
 Cont. Caudal
ADVANTAGES:
•good pain relief

•the patient is alert and cooperative

•there is decreased danger of neonatal

depression.
 Cont. Caudal
SIDE EFFECTS:
•Hypotension secondary to peripheral
vasodilation.
•Sensory changes and loss of the ability to
move lower extremities.
•Ringing in the ears, lightheadedness,
circumoral (around mouth) tingling, numbness,
metallic taste, and seizures.
•Burning at the site of injection.
 GENERAL
ANESTHESIA
 General Anesthesia
General anesthesia produces loss of
sensation and loss of consciousness. It is
seldom indicated for uncomplicated
vaginal delivery. It is used in cases of
fetal distress requiring immediate
delivery and used for C-section when
spinal anesthesia is contraindicated.
 Cont. G.A
DISADVANTAGES:
(1)The patient is unable to participate.
(2) It rapidly crosses the placenta causing fetal
anesthesia, respiratory depression, and possible
anoxia (loss of oxygen).
(3) There is increased risk of maternal
aspiration -- evaluate how recently the patient
has eaten.
(4) There is possible hemorrhage since nitrous
 -End-
Prepared by: Edderlyn D. Lamarca
Saint John Colleges