Pain Relief and Having a Baby
Pain during labour is often described as being one of the most painful experience a person can have. Individuals will have a different experience depending on coping mechanisms and pain relief available. The type and availability of pain relief should be discussed and planned with an obstetrician and midwife before labour commences.
Management of labour pain can be non-intrusive measures like relaxation or comfort therapy (heat/cold therapy, hypnotherapy, music therapy), touch therapy (massage, acupressure) and transcutaneous electrical nerve stimulation (TENS). Medical management may include nitrous oxide gas, intramuscular or intravenous pain medications (Pethidine, Morphine, Remifentanil).
An anaesthetist can offer an epidural which is the most effective mode of pain relief during labour. Should there be a need for caesarean section, regional anaesthesia (spinal block or combined spinal epidural) or general anaesthesia may be offered if an effective epidural was not established during labour.
The Australia and New Zealand College of Anaesthetist (ANZCA) produced an information handout “Pain relief and having a baby” downloadable here.
Epidural anaesthesia is the most effective pain relief available during labour. Medication is given via a soft plastic catheter placed, through the skin of the back, into the epidural space surrounding the spinal cord. Using local anaesthetics to numb the skin, the process to insert an epidural is usually tolerated well. Patients will be positioned to a curved back posture to facilitate insertion.
Depending on the anatomy of the patient, insertion of an epidural anaesthesia takes around 15-30 minutes. After the initial dose of medication, labour pain will start to reduce in 5-10 minutes although the full effect of epidural is felt after 15-20minutes.
The Australia and New Zealand College of Anaesthetist (ANZCA) provides detailed information about risks of epidural anaesthesia on their website. An ANZCA produced information handout “Pain relief and having a baby” is downloadable here.
A spinal block is commonly offered as the anaesthesia for caesarean section. This procedure involves an injection on the back to place medication in the fluid surrounding the spinal cord. The onset of block is fast and reliable. Patients will not feel any pain during caesarean section and will be unable move their legs for several hours. Of note, the sensation of pressure and movement is not eliminated. An effective spinal block will lower the blood pressure. A common symptom as this happen is nausea. The anaesthetist will monitor the blood pressure closely and provide treatment as needed.
Combined spinal epidural (CSE) is when both spinal and epidural block is done simultaneously. Sometimes, this is provided for labour pain or caesarean section.
Although neuraxial block (spinal or combined spinal epidural) is the safest anaesthetic option for caesarean section, general anaesthesia which carries a higher risk of airway complications (specifically aspiration and failed intubation), may be required in certain situations. Examples include:
- Emergency caesarean section where time does not permit placement of a neuraxial block
- Failed neuraxial block
- High risk of bleeding from blood thinners
- Maternal refusal of neuraxial block
Pain control after caesarean section will consists of different painkillers given incrementally. Simple analgesia like paracetamol, non-steroidal anti-inflammatory drugs (NSAIDS) together with opioids (e.g. tramadol and oxycodone) form the basis of this multimodal approach. Sometime, intravenous opioids may be used.
If the caesarean section was done under spinal and/or epidural anaesthesia, the medication used can include an opioid that will provide up to 24 hours of pain relief. The epidural catheter may also be left in to provide ongoing pain relief for up to 48 hours. Possible side effect includes itch, nausea and vomiting.
Anaesthesia for Eye Surgery
Procedures on the eye can be performed under general anaesthesia, eye block or topical eye drops. Patients having cataract surgery usually have topical eye drops or an eye block for anaesthesia. Although pain is not felt during the procedure, patients may have sensation of movement and pressure. During the short procedure, light sedation may be given. Patients will have to lie flat with a surgical drape over the face.
If you are unable to lie flat or cannot tolerate having your face covered because of medical reasons, please alert your anaesthetist before the procedure.
The Australia and New Zealand College of Anaesthetist (ANZCA) produced an information handout “Anaesthesia for eye surgery" downloadable here.
An eye block is done to numb and stop movement of the eye. It usually involves one or two injections around the eye. Light sedation may be given during the block. During eye surgery, pain is not felt but patients may have sensation of movement and pressure.
Patients may get a bruise from the eye block but rare complications like eye injury, allergic reaction and bleeding into the eye will be monitored by the anaesthetist.
The Australia and New Zealand College of Anaesthetist (ANZCA) produced an information handout “Anaesthesia for eye surgery" downloadable here.
Other Procedures
These day-procedures are commonly performed under deep (procedural) sedation. In gastroscopy, a flexible scope is passed through the mouth into the gullet, stomach and small bowel. A mouth guard will be placed between the teeth during gastroscopy to protect both the teeth and scope from damage. For colonoscopy, the scope is passed into the back passage to visualise the large bowel.
Most sedated patients will not remember the entire endoscopy procedure. However, being sedation and not general anaesthesia, some patients may recall fragments of the process. It is important to alert the anaesthetist if one is uncomfortable during the procedure.
The Australia and New Zealand College of Anaesthetist (ANZCA) produced an information handout “Anaesthesia for endoscopy" downloadable here.
Joint replacement of the shoulder, hip or knee are major operations often performed in the elderly population. Managing their health conditions during anaesthesia and pain relief after surgery are the main issues for joint replacement anaesthesia.
General anaesthesia is often the anaesthetic of choice in shoulder replacement but a neuraxial block (spinal or combined spinal epidural) may be offered instead for hip and knee replacement. Regional anaesthesia nerve block is commonly implemented for pain control afterwards.
The Australia and New Zealand College of Anaesthetist (ANZCA) produced an information handout “Anaesthesia for joint replacement" downloadable here.
Analgesia (Pain Relief)
This includes any pain medication that is given to you as an injection, tablet or as a skin patch.
You will often be prescribed regular medications such as paracetamol, anti-inflammatories or other drugs such as Tapentadol or Pregabalin. You will also have other medications you can ask for when you require them.
Depending on your operation, you may be prescribed a ‘PCA’ (patient controlled analgesia) where you press a button and a dose of pain relief is given through your drip. Each hospital has different protocols as well as access to the Acute Pain Service who may also be involved in your care after your operation.
The pain medications prescribed for after your operation are only to be used for this operation. Once you have recovered it is important that you dispose of them safely.
These are often referred to as ‘spinal' or "epidural block’ and can be performed as the sole anaesthetic technique whereby you do not require any sedating medications or can be done in conjunction with sedation or general anaesthesia.
Spinal anaesthesia: A small needle is used in the lower back to inject local anaesthetic which results in your legs and lower abdomen becoming numb. This is often used for patients having joint replacements, for obstetric and gynaecological procedures as well as urological and vascular operations. Pain medications can be placed at the same time to provide up to 24 hours of pain relief.
Some of the benefits include a reduction in blood loss, very good pain relief during and immediately after the operation and a reduction in blood clots in the legs (DVT).
Epidural: From the patient’s point of view, this is very similar to a spinal anaesthetic although there are a few key differences. Anatomically, the local anaesthetic is delivered to a different space, a different type of needle is used and a small plastic catheter is threaded so that pain relief can be continued for longer periods of time. This is the pain relief technique used commonly for women in labour.
Some of the reasons that these blocks would not be appropriate for you include:
- If you take blood thinning medications (the decision to stop blood thinning medication must be made by discussion with your anaesthetist/surgeon/cardiologist)
- Low platelet count or clotting abnormalities
- If you have a systemic infection or skin infection over the site where the block would be performed
- You do not consent to it
Your anaesthetist may discuss specific nerve blocks with you where they can numb all or part of your arm, leg or abdomen. Catheters are sometimes inserted to provide you with a longer period of pain relief. These are commonly used in orthopaedic surgery.
About Anaesthesia
What is Anaesthesia
Types of Anaesthesia
Specific Procedures
Cost