Local Perineal Anesthesia local blocks lidocaine for episiotomy pudendal blocks Regional Anesthesia Epidural most common...
Local Perineal Anesthesia
- local blocks
- lidocaine for episiotomy
- pudendal blocks
Epidural
- most commonly used technique for both labour and delivery
- does not prolong first stage, but may reduce maternal expulsive efforts
- 0.25% bupivacaine (Marcaine) usually used for labour (longer acting compared to lidocaine and less motor block)
- 2% lidocaine (Xylocaine) usually used for vaginal deliveries and C-section in varying doses
- 19 gauge indwelling catheter inserted into lumbar epidural space
- preload mother with 500-1000 mL IV fluid to prevent maternal hypotension associated with epidural (fetal depression rare if maternal hypotension avoided)
- test dose given first to check for spinal block followed by another dose to rule out intravascular injection - if nodizziness or tinnitus, rest of dose is given
- complications: inadvertent total spinal with cardiovascular collapse and respiratory arrest, intravascular injection with seizures, post-ictal depression and possible cardiac arrest
- goal is effective analgesia with no motor blockade
- 0.125% bupivacaine plus low dose fentanyl
Spinal block
- for C-section need anesthesia of T4-T8
- injection of local anesthetic into subarachnoid space
- fastest onset
- least drug exposure for fetus because small dose required
- not appropriate for labour due to intense motor blockade
- beware of rapid hypotension and preload mother with 1000 mL IV fluid
- not used for vaginal deliveries
- rapid sequence induction to prevent aspiration
- pre-oxygenate mother with 100% O2as she is prone to hypoxia during intubation secondary to decreased FRC and increased O2 consumption
