Furthermore, the timing of the epidural had no impact on the likelihood of needing an assisted birth involving forceps or suction or on the amount of time spent in the second stage-the pushing stage-of labor, the authors noted. In addition, Apgar scores and cord pH for the baby were not different between the early and late groups.
One question that remains is if the timing of an epidural has an impact on the time it takes for a woman to reach full cervical dilation. Epinephrine is often used adjunctively with the epidural to prolong the duration of the block, reduce bleeding, and decrease the toxicity of the anesthetic.
Perhaps the most common complication of epidural anesthesia is postdural puncture headache. The headache usually results when leakage of cerebrospinal fluid leads to a reduction in intracranial pressure and compensatory cerebral vasodilation.
The use of epidural anesthesia increases the risk of vacuum- or forceps-assisted vaginal delivery. Administration of epidural anesthesia can cause hypertonic uterine contractions, possibly owing to a rapid increase in plasma epinephrine levels that leads to reduced beta-agonist tocolytic activity.
This phenomenon, which may result from a very rapid onset of analgesia, can be reversed with the use of IV terbutaline mcg, nitroglycerin 50 to mcg, or sublingual nitroglycerin spray.
Maternal BP may fall as a result of the elimination of painful stimuli and the onset of peripheral vasodilation. Although a modest decrease in BP may not have a significant effect, a large decrease may reduce uteroplacental blood flow and pose a threat to the fetus. For this reason, it is important to prevent, or promptly treat, significant hypotension. Administration of an isotonic electrolyte solution e.
Rare but serious complications of epidural anesthesia include neurologic injury, epidural hematoma, and deep epidural infection. Persistent neurologic injury is noted in 1 in , patients; transient neurologic injury is more common, occurring in 1 in 6, High doses of local anesthetic injected intrathecally can cause high spinal block, which presents as respiratory compromise. Accidental high-dose IV injection can lead to seizures and cardiac arrest. To detect accidental subarachnoid or IV catheter placement, an epidural test dose is recommended.
This typically involves administration of 1. Studies have shown that epidural analgesia does not have a statistically significant impact on cesarean section risk, maternal satisfaction with pain relief, or long-term backache. Furthermore, epidural analgesia does not appear to have an immediate effect on neonatal status as determined by Apgar scores. Contraindications to any form of neuraxial anesthesia during labor include patient refusal, active maternal hemorrhage, increased intracranial pressure, septicemia, infection at or near the puncture site, and clinical signs of coagulopathy including ongoing thromboprophylaxis with low-molecular-weight or unfractionated heparins.
Pharmacists are instrumental in the administration of epidural anesthetics in a number of ways. For one, pharmacists can actively participate in the development of prescribing guidelines for epidural analgesics and in the coprescribing of balanced analgesia, an opioid antagonist, and antiemetics.
Furthermore, they should write or review the information in patient-information leaflets regarding epidural infusions to ensure that the pharmacologic information is accurate and appropriate. Pharmacists can also devise policies that ensure the safe and legal handling, storage, administration, and disposal of controlled drugs used in epidural infusions.
Epidurals that are formulated in the local hospital pharmacy should be aseptically prepared and appropriately labeled and stored, with preparation overseen by a pharmacist.
Furthermore, it is important that pharmacists regularly monitor prescriptions for epidural solutions when preprinted prescriptions are not utilized, as well as prescriptions for adjuvant therapies such as antiemetics and opioid antagonists.
Whether you have an epidural or not makes no difference to the chance of you having a caesarean section. Learn more here about the development and quality assurance of healthdirect content.
Every woman experiences pain in a different way. The way you experience pain depends on your emotional, psychological, social, motivational and cultural circumstances. Every woman responds and copes differently with the pain of labour and childbirth.
Almost all women experience pain during childbirth which varies in severity. There are different pharmacological and non-pharmacological approaches to treatment of pain during childbirth. Read more on HealthEngine website. Learn what options are available to you to relieve pain during labour pain, and how your birth support partner can help you. How does an epidural work? With an epidural, a small plastic tube is inserted between the bones of your spine, into the space around your spinal cord.
A combination of drugs is given through the tube. A local anaesthetic blocks nerves in the spinal cord that transmit pain signals and an opiate provides further pain relief. Read more on Australian Breastfeeding Association website. Being abdominal surgery, pain in the early months is very common after a caesarean section C-section and needs to be managed with rest, pain relief, and.
Read more on Australasian Birth Trauma Association website. Induced labour is a medical treatment to start labour. It may be recommended if your baby needs to be born before labour is due to start naturally.
Learn more about labour complications. While the medicine wear off, you'll probably be advised to rest in a lying or sitting position until the feeling in your legs returns. Epidurals are usually safe, but there's a small risk of side effects and complications, including:. Read more about the side effects and complications of an epidural. Page last reviewed: 11 March Next review due: 11 March Overview - Epidural Contents Overview Side effects.
An epidural is an injection in your back to stop you feeling pain in part of your body. When epidurals are used Epidurals can be used: during labour and childbirth , including caesareans during some types of surgery after some types of surgery Steroid medicine can also be given with an epidural injection, to treat pain in your back or leg that's caused by sciatica or a slipped prolapsed disc.
Preparing for an epidural If you have any concerns or questions about having an epidural, discuss these with your doctor. You may be given specific advice about eating, drinking and medicines before the epidural.
0コメント