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Regional
anesthesia: temporary loss of sensation produced by injecting anesthetic
agent (local) into direct contact with
nervous tissue. Most common types in OB: epidural, spinal, & combined
epidural-spinal blocks. Epidurals are used for analgesia during vaginal
births and anesthesia in C-sections.
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Absorption of
agents depends on vascularity of area of injection. Usually hydrate woman
well. Several types used. Most familiar with opiods used with epidural
blocks: morphine, fentanyl, butorphanol, & meperidine. Various
combinations are used.
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Reactions
anesthetic agents: palpitations, tinnitus, metallic tase, N&V, itching;
severe include hypotension, resp depression, cardiac arrest.
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Epidural:
anesthetic injected into epidural space; usually used continuously; given as
soon as active labor established. ADVANTAGES: woman fully awake; discomfort
relieved; actively participates.
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DISADVANTAGES:
maternal hypotension; less effective pushing; delay in return of bladder
sensation
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CONTRAINDICATIONS:
client refusal, maternal problems with blood coagulation, allergy to drug,
hypovolemic shock.
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Nursing
management: enc pt. to empty bladder;
start large-bore IV; help woman to position for adequate spinal flexion;
monitor for hypotension, HA, return of sensation; pruritis, resp depression
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