Epidural narcotic after birth:
provides narcotic analgesia for approx 24 hrs after birth. Anesthesiologists
injects opioid such as morphine sulfate (Duramorph) into epidural space STAT
/p birth. SE: pruritis, N&V, urinary retention. Resolves in 14 – 16 hrs.
Drug guide: p 389
Spinal block: local anesthetic is
injected into spinal fluid in spinal canal to provide anesthesia for C-sec,
rarely for vag. ADVANTAGE: STAT onset of anesthesia, easy to administer,
smaller dose, maintenance of muscle tone (+ or -)
DISADVANTAGE: high incidence of
maternal hypotension, →
fetal hypoxia.
CONTRAINDICATED in severe hypovolemia, CNS disease; infection over puncture site, +
same as epidural
Pudendal block – transvaginal administration; provides
perineal anesthesia but no
relief of contraction discomfort. Easy to administer, absence of maternal hypotension; no need to monitor
FHR. May decrease urge to push; may perforate rectum or sciatic
nerve
Local anesthesia: injecting agent into areas of perineum
for episiotomy incision
or repair.