Labor and Delivery Analgesics
Systemic Analgesics
- Meperidine (Demerol): Most commonly used opioid during labor, crosses placenta rapidly and can cause respiratory depression in newborn if given within 2-4 hours of delivery
- Morphine: Longer acting than meperidine, used early in labor to promote rest and cervical dilation
- Fentanyl: Rapid onset, short duration, less neonatal respiratory depression than meperidine
Critical Alert: Never administer systemic opioids if delivery is expected within 2-4 hours due to peak neonatal depression risk
Key Points
- Monitor maternal respirations (≥12/min) and fetal heart rate continuously
- Have naloxone (Narcan) readily available for maternal and neonatal reversal
- Assess pain relief effectiveness and maternal sedation level
Regional Anesthesia
- Epidural anesthesia: Provides continuous pain relief, allows maternal participation in delivery, may slow labor progress requiring oxytocin augmentation
- Spinal anesthesia: Single injection providing complete anesthesia for cesarean delivery, rapid onset with risk of maternal hypotension
- Combined spinal-epidural (CSE): Provides immediate pain relief with continuous dosing capability
Clinical Scenario
A laboring client receives an epidural at 6cm dilation. Her blood pressure drops from 130/80 to 90/50 mmHg. Priority nursing actions include positioning client on left side, increasing IV fluids, administering oxygen, and notifying anesthesiologist.
- Pre-procedure: Establish IV access, obtain baseline vital signs, ensure informed consent
- During procedure: Position client (sitting or side-lying), monitor vital signs every 5 minutes
- Post-procedure: Assess motor/sensory function, monitor for hypotension, maintain bed rest
Newborn Pain Management
Neonatal Analgesics
- Acetaminophen: Safe and effective for newborns, dosed at 10-15 mg/kg every 6-8 hours, avoid if hepatic dysfunction
- Morphine: Used for severe pain or post-operative care, requires careful monitoring for respiratory depression
- Fentanyl: Preferred for mechanically ventilated infants, shorter duration than morphine
Critical Alert: Newborns metabolize drugs differently - always verify dosing calculations and monitor for signs of toxicity
Key Points
- Use non-pharmacological measures first: swaddling, pacifiers, skin-to-skin contact
- Monitor respiratory status closely - newborns are more sensitive to opioid effects
- Assess pain using neonatal pain scales (NIPS, PIPP)
Study Tips and Memory Aids
Memory Aid: SAFE Pain Management
Screen for allergies, Assess pain level, Fetal monitoring, Evaluate effectiveness
Quick Check Questions
- □ Can you identify contraindications for epidural anesthesia?
- □ Do you know the antidote for opioid overdose in mother and newborn?
- □ Can you explain why NSAIDs are preferred for postpartum pain?
- □ Do you understand timing considerations for systemic analgesics?