week 12
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Questions and Answers

Which area of the CNS is responsible for coordinating the emetic response?

  • Cerebellum
  • Vomiting Centre
  • Chemoreceptor Trigger Zone (correct)
  • Hypothalamus

    • What triggers the vomiting reflex?

  • Activation of the cerebellum
  • Sensory input from the skin
  • Stimulation of receptors in the upper GI tract (correct)
  • Hormonal changes in the pancreas

    • Which receptors are thought to be key in the activation of the vomiting reflex?

  • Serotonin receptors
  • Nicotinic receptors
  • H1 receptors (correct)
  • Dopamine receptors

    • What is the impact of severe NVP on pregnant women?

    <p>Loss of job productivity</p> Signup and view all the answers

    What condition lies on the extreme end of NVP?

    <p>Hyperemesis Gravidarum</p> Signup and view all the answers

    Which area of the CNS controls the emetic response?

    <p>Coordinating centre</p> Signup and view all the answers

    Which type of general anesthetic is given by injection often to induce general anesthesia?

    <p>Parenteral general anesthetics</p> Signup and view all the answers

    What is the mode of action of ketamine, a parenteral general anesthetic?

    <p>Inhibition of NMDA receptor</p> Signup and view all the answers

    Which general anesthetic is known for causing four stages of analgesia, including delirium and depression of vital centers of medulla?

    <p>Nitrous oxide</p> Signup and view all the answers

    What can lead to hypoxia in the fetus when nitrous oxide is used?

    <p>Maternal hypoventilation and vasoconstriction of placental arteries</p> Signup and view all the answers

    What is a main cause of mortality associated with general anesthetics?

    <p>Failed intubation</p> Signup and view all the answers

    What is the goal of providing general anesthesia?

    <p>To provide absence of pain, involuntary movement, and autonomic reflexes</p> Signup and view all the answers

    What is the typical dosing of DICLECTIN for nausea and vomiting of pregnancy (NVP)?

    <p>4 tablets a day</p> Signup and view all the answers

    Which adverse reaction is associated with DICLECTIN?

    <p>Diarrhea</p> Signup and view all the answers

    What is the half-life of diclofenac?

    <p>3 hours</p> Signup and view all the answers

    Which adverse effect is associated with naproxen use for postpartum pain?

    <p>Excretion in breast milk</p> Signup and view all the answers

    What is the first-line therapy for nausea and vomiting of pregnancy (NVP)?

    <p>DICLECIN</p> Signup and view all the answers

    What is the specific action of DICLECTIN in the body?

    <p>Antagonism of histamine type 1 receptors</p> Signup and view all the answers

    Which type of local anesthetic is primarily hepatically metabolized and has a slower breakdown?

    <p>Amide local anesthetics</p> Signup and view all the answers

    Which local anesthetic has an onset of action in 5-10 minutes and provides pain control for about 2X longer than lidocaine and 3X longer than chloroprocaine?

    <p>Bupivacaine</p> Signup and view all the answers

    Which local anesthetic was removed from the Canadian market in 2012?

    <p>Chloroprocaine</p> Signup and view all the answers

    Which type of fibers do local anesthetics block?

    <p>C fibers</p> Signup and view all the answers

    Which drug has an antiplatelet effect and should be avoided with other anticoagulants and antiplatelet drugs like ibuprofen and ASA?

    <p>Naproxen</p> Signup and view all the answers

    Which local anesthetic provides anesthesia for less than 30 minutes and has a short half-life?

    <p>Lidocaine</p> Signup and view all the answers

    Where do opioids primarily act in the body to alleviate pain during labor?

    <p>At the dorsal horn of the spinal cord</p> Signup and view all the answers

    What is the primary cause of pain during the first stage of labor?

    <p>Dilation of the cervix</p> Signup and view all the answers

    Approximately what percentage of women in labor at Ontario hospitals will receive some form of regional anesthesia?

    <p>64%</p> Signup and view all the answers

    Where does the spinal cord end?

    <p>At L1</p> Signup and view all the answers

    What is the primary difference between epidural anesthesia and subarachnoid anesthesia?

    <p>Subarachnoid anesthesia works faster than epidural anesthesia</p> Signup and view all the answers

    What is the primary effect of NSAIDs in pain management during labor?

    <p>Blocking PG synthesis, impeding the passage of pain impulses</p> Signup and view all the answers

    What triggers the vomiting reflex?

    <p>Stimulation of receptors in the upper GI tract</p> Signup and view all the answers

    Which area of the CNS controls the emetic response?

    <p>Vomiting Centre</p> Signup and view all the answers

    What is the primary impact of severe NVP on pregnant women?

    <p>Anxiety and worry about the fetus</p> Signup and view all the answers

    What are the coordinating centers for the emetic response?

    <p>Vomiting Centre and Chemoreceptor Trigger Zone</p> Signup and view all the answers

    What is the purpose of the vomiting reflex?

    <p>Defend the body against pathogens</p> Signup and view all the answers

    What is the impact of NVP on relationships?

    <p>Negative impact</p> Signup and view all the answers

    What is the primary mode of action of inhalational general anesthetics?

    <p>Disruption of lipid bilayer and structure of receptors mediating neuronal stimulation</p> Signup and view all the answers

    Which type of general anesthetic is associated with a rapid onset of action and short half-life?

    <p>Parenteral general anesthetics</p> Signup and view all the answers

    What is the primary effect of nitrous oxide (ENTONOX) on the body?

    <p>Increases delivery of gas to blood with increased ventilation</p> Signup and view all the answers

    What is a potential danger associated with nitrous oxide (ENTONOX) use in labor?

    <p>Excessive maternal hypoventilation</p> Signup and view all the answers

    Which adverse effect is associated with general anesthetics due to their hypotensive effects?

    <p>Aspiration</p> Signup and view all the answers

    What is the primary mechanism of action of parenteral general anesthetics such as ketamine and barbiturates?

    <p>Inhibition of neuronal firing through alteration of ligand-gated ion channels</p> Signup and view all the answers

    Which type of local anesthetic has a slower breakdown due to hepatic metabolism?

    <p>Bupivacaine</p> Signup and view all the answers

    What is the maximum duration of blockade for chloroprocaine?

    <p>30-60 minutes</p> Signup and view all the answers

    Which local anesthetic was removed from the Canadian market in 2012?

    <p>Chloroprocaine</p> Signup and view all the answers

    What is the half-life of ibuprofen for post-partum pain?

    <p>2 hours</p> Signup and view all the answers

    Which local anesthetic provides anesthesia for less than 30 minutes and has a short half-life?

    <p>Chloroprocaine</p> Signup and view all the answers

    What is the onset of action for bupivacaine in minutes?

    <p>3-5 minutes</p> Signup and view all the answers

    Which type of anesthesia is often called a 'spinal' or intrathecal injection, providing clear endpoints and working faster than epidural anesthesia?

    <p>Subarachnoid anesthesia</p> Signup and view all the answers

    Where does the spinal cord end, and below which level does the spine continue as spinal nerves called the cauda equina?

    <p>Ends at L1, below L1</p> Signup and view all the answers

    Where do opioids primarily act in the body to alleviate pain during labor?

    <p>In the dorsal horn of the spinal cord</p> Signup and view all the answers

    What is the primary cause of pain during the second stage of labor?

    <p>Distention of the pelvic floor, vagina, and perineum</p> Signup and view all the answers

    Which of the following is true about the impact of regional anesthesia at the level of the lumbar spine?

    <p>It affects the sympathetic nervous system</p> Signup and view all the answers

    What is the impact of NSAIDs in pain management during labor?

    <p>They impede the passage of pain impulses</p> Signup and view all the answers

    What is the primary difference between DICLECTIN and NSAIDs like diclofenac and naproxen in terms of usage for postpartum pain control?

    <p>DICLECTIN is used for nausea and vomiting of pregnancy (NVP) while diclofenac and naproxen are used for postpartum pain control.</p> Signup and view all the answers

    What is the typical dosing of DICLECTIN for nausea and vomiting of pregnancy (NVP)?

    <p>4 tablets a day</p> Signup and view all the answers

    What is the primary difference between diclofenac and naproxen in terms of availability and prescription status?

    <p>Diclofenac is a prescription-only analgesic, while naproxen is available in over-the-counter and prescription doses.</p> Signup and view all the answers

    What are the adverse effects associated with diclofenac and naproxen use for postpartum pain?

    <p>Excretion in breast milk and contraindication in pregnancy</p> Signup and view all the answers

    What are the symptoms of DICLECTIN overdose and the recommended treatment?

    <p>Restlessness, dry mouth, dilated pupils, and treatment involves gastric lavage</p> Signup and view all the answers

    What is the mode of action of DICLECTIN in the treatment of nausea and vomiting of pregnancy (NVP)?

    <p>Acts as a histamine antagonist that binds to histamine type 1 receptors</p> Signup and view all the answers

    What is the primary cause of nausea & vomiting of pregnancy (NVP)?

    <p>Rising estrogen and progesterone levels</p> Signup and view all the answers

    Which area of the CNS controls the emetic response?

    <p>Vomiting Centre</p> Signup and view all the answers

    What triggers the vomiting reflex?

    <p>Stimulation of receptors in the upper GI tract</p> Signup and view all the answers

    What is the severe form of NVP compared to the severity of nausea caused by chemotherapy?

    <p>Hyperemesis Gravidarum</p> Signup and view all the answers

    Which nerves induce emesis by stimulating the vomiting centre?

    <p>Afferent nerves</p> Signup and view all the answers

    What is the coordinating centre in the CNS that controls the emetic response?

    <p>Chemoreceptor Trigger Zone</p> Signup and view all the answers

    Which type of general anesthetic is associated with a rapid onset of action and short half-life?

    <p>Thiopental</p> Signup and view all the answers

    What is the primary mode of action of ketamine, a parenteral general anesthetic?

    <p>Blockade of NMDA receptor</p> Signup and view all the answers

    What are the effects of nitrous oxide (ENTONOX) on the body?

    <p>Increased delivery of gas to blood with increased ventilation</p> Signup and view all the answers

    What are the adverse effects associated with general anesthetics due to their hypotensive effects?

    <p>Nausea and vomiting</p> Signup and view all the answers

    What is the primary cause of mortality associated with general anesthetics?

    <p>Failed intubation</p> Signup and view all the answers

    What is the goal of providing general anesthesia?

    <p>To provide absence of pain, involuntary movement, and autonomic reflexes</p> Signup and view all the answers

    What is the first-line therapy for Nausea and Vomiting of Pregnancy (NVP)?

    <p>Doxylamine succinate and pyridoxine hydrochloride (DICLECTIN)</p> Signup and view all the answers

    What is the primary adverse effect of DICLECTIN?

    <p>Excretion in breast milk</p> Signup and view all the answers

    What is the typical dosing of DICLECTIN for NVP?

    <p>4 tablets a day</p> Signup and view all the answers

    Which NSAID is more specific for COX2 than COX1 and is used for postpartum pain relief and inflammation?

    <p>Diclofenac</p> Signup and view all the answers

    What is the primary adverse effect of naproxen use for postpartum pain?

    <p>Contraindication in pregnancy</p> Signup and view all the answers

    What is the primary method of treatment for DICLECTIN overdose?

    <p>Gastric lavage</p> Signup and view all the answers

    What is the primary cause of pain during the first stage of labor?

    <p>Dilation of the cervix and distention of the lower uterine segment</p> Signup and view all the answers

    Where does the spinal cord end, and below which level does the spine continue as spinal nerves called the cauda equina?

    <p>L1; Below L1</p> Signup and view all the answers

    What is the primary difference between epidural anesthesia and subarachnoid anesthesia?

    <p>Speed of onset and clear endpoints</p> Signup and view all the answers

    Approximately what percentage of women in labor at Ontario hospitals will receive some form of regional anesthesia?

    <p>64%</p> Signup and view all the answers

    Where do opioids primarily act in the body to alleviate pain during labor?

    <p>Dorsal horn of the spinal cord</p> Signup and view all the answers

    What is the impact of NSAIDs in pain management during labor?

    <p>Block PG synthesis, impeding the passage of pain impulses</p> Signup and view all the answers

    What is the primary difference between amide and ester local anesthetics?

    <p>Amide local anesthetics have slower breakdown due to hepatic metabolism, while ester local anesthetics are rapidly broken down in the blood by esterases</p> Signup and view all the answers

    Which local anesthetic was removed from the Canadian market in 2012?

    <p>Chloroprocaine</p> Signup and view all the answers

    What is the onset of action for bupivacaine in minutes?

    <p>5-10 minutes</p> Signup and view all the answers

    Which type of nerves do local anesthetics block?

    <p>B fibers and C fibers</p> Signup and view all the answers

    What is the maximum duration of blockade for chloroprocaine?

    <p>30-40 minutes</p> Signup and view all the answers

    What is the primary danger associated with bupivacaine toxicity?

    <p>Cardiac arrest and ventricular arrhythmia</p> Signup and view all the answers

    What is the primary cause of chronic pain?

    <p>Pain that persists beyond the reasonable time for an injury to heal</p> Signup and view all the answers

    What is the primary characteristic of visceral pain?

    <p>Associated with autonomic reflexes like tachycardia and sweating</p> Signup and view all the answers

    What is a common symptom associated with the acute flaring of visceral pain?

    <p>Nausea and vomiting</p> Signup and view all the answers

    What is the primary cause of acute visceral pain?

    <p>Early ischemia or inflammation</p> Signup and view all the answers

    What is a key characteristic of chronic pain?

    <p>Persists one month beyond the usual course of an acute disease</p> Signup and view all the answers

    What is the primary sensation associated with visceral pain?

    <p>Dull and aching</p> Signup and view all the answers

    What is a common outcome of acute flaring of visceral pain?

    <p>Sweating and tachycardia</p> Signup and view all the answers

    What is a distinguishing feature of acute pain?

    <p>Has an obvious cause</p> Signup and view all the answers

    What is a common outcome of the onset of acute pain?

    <p>Tachycardia and sweating</p> Signup and view all the answers

    What is a key characteristic of chronic pain?

    <p>Persists beyond the reasonable time for an injury to heal</p> Signup and view all the answers

    What is the reason why NSAIDs are generally not recommended during pregnancy?

    <p>They are associated with premature ductal closure</p> Signup and view all the answers

    Why should people with peptic ulcers and known sensitivity to tNSAIDs avoid naproxen?

    <p>It may lead to gastrointestinal bleeding</p> Signup and view all the answers

    What is the primary concern regarding the excretion of naproxen in breast milk?

    <p>It may yield tiny doses to the newborn</p> Signup and view all the answers

    Why should other anticoagulants and antiplatelet drugs be avoided with naproxen?

    <p>Naproxen has an antiplatelet effect</p> Signup and view all the answers

    What is the reason for recommending avoidance of NSAIDs during pregnancy?

    <p>They may be mildly teratogenic in the first trimester</p> Signup and view all the answers

    What is the potential risk associated with NSAIDs near term during pregnancy?

    <p>Bleeding problems (e.g., intracranial hemorrhage)</p> Signup and view all the answers

    Why are NSAIDs not recommended for postpartum pain?

    <p>They are associated with premature ductal closure</p> Signup and view all the answers

    What is the primary concern for people with known sensitivity to tNSAIDs regarding naproxen use?

    <p>It may lead to gastrointestinal bleeding</p> Signup and view all the answers

    What is the potential risk associated with naproxen excretion in breast milk?

    <p>It may yield tiny doses to the newborn</p> Signup and view all the answers

    Why should other anticoagulants and antiplatelet drugs be avoided with naproxen?

    <p>Naproxen has an antiplatelet effect</p> Signup and view all the answers

    What type of pain is mainly involved in labor?

    <p>Visceral pain</p> Signup and view all the answers

    What is the primary source of deep somatic pain?

    <p>Muscles and tendons</p> Signup and view all the answers

    What is the primary adverse effect of diclofenac and naproxen use for postpartum pain?

    <p>Gastrointestinal distress</p> Signup and view all the answers

    What is the primary mode of metabolism for diclofenac?

    <p>Biliary excretion</p> Signup and view all the answers

    What is the primary difference between diclofenac and naproxen in terms of specificity?

    <p>Diclofenac is more specific for COX-2</p> Signup and view all the answers

    What is the primary cause of postpartum pain?

    <p>Perineal tearing</p> Signup and view all the answers

    What is the primary reason diclofenac is not recommended during early or late pregnancy?

    <p>Potential fetal complications</p> Signup and view all the answers

    What is the primary excretion route for naproxen?

    <p>Renal excretion</p> Signup and view all the answers

    What is the primary adverse effect of long-term use of naproxen?

    <p>Gastrointestinal side effects</p> Signup and view all the answers

    What is the primary effect of diclofenac on COX-1 and COX-2?

    <p>Inhibits both COX-1 and COX-2</p> Signup and view all the answers

    What type of pain mainly involves acute visceral pain in labor?

    <p>Visceral pain</p> Signup and view all the answers

    What is the primary cause of postpartum pain associated with acute somatic pain?

    <p>Cervix stretching and tearing</p> Signup and view all the answers

    Which medication inhibits both COX-1 and COX-2, and is mainly metabolized by the liver?

    <p>Diclofenac</p> Signup and view all the answers

    What is a potential risk associated with the use of diclofenac during early or late pregnancy?

    <p>Fetal complications</p> Signup and view all the answers

    Which adverse effect is associated with naproxen use for postpartum pain?

    <p>GI distress</p> Signup and view all the answers

    What is the primary mode of excretion for diclofenac metabolites?

    <p>Excretion in urine</p> Signup and view all the answers

    What is the primary difference between diclofenac and naproxen in terms of specificity for COX-2?

    <p>Diclofenac is more specific</p> Signup and view all the answers

    What is the primary source of deep somatic pain?

    <p>Muscles</p> Signup and view all the answers

    What is the primary mode of action of diclofenac?

    <p>COX-1 inhibition</p> Signup and view all the answers

    What is the primary adverse effect of diclofenac use for postpartum pain?

    <p>GI distress</p> Signup and view all the answers

    What is the typical duration that defines chronic pain?

    <p>More than three months</p> Signup and view all the answers

    Which autonomic reflexes are often associated with acute flaring of visceral pain?

    <p>Nausea, vomiting, and sweating</p> Signup and view all the answers

    What is the primary cause of visceral pain?

    <p>Stretching of unmyelinated fibres that innervate the walls or capsules of organs</p> Signup and view all the answers

    What is a common outcome of the onset of acute pain?

    <p>Tachycardia, an increase in blood pressure, and sweating</p> Signup and view all the answers

    What is the primary description of visceral pain?

    <p>Dull and aching</p> Signup and view all the answers

    What is a typical characteristic of chronic pain?

    <p>Pain that persists beyond the reasonable time for an injury to heal</p> Signup and view all the answers

    What is the typical association of acute flaring of visceral pain with autonomic reflexes?

    <p>Nausea, vomiting, and sweating</p> Signup and view all the answers

    What is the primary result of noxious stimuli on the levator ani muscle in terms of visceral pain?

    <p>Felt in the immediate area of the buttocks region</p> Signup and view all the answers

    What is the typical duration of pain that defines acute pain?

    <p>Does not last</p> Signup and view all the answers

    What is a common outcome of the onset of acute pain in terms of physiological response?

    <p>Tachycardia, an increase in blood pressure, and sweating</p> Signup and view all the answers

    What is the primary concern regarding NSAID use during pregnancy?

    <p>Potential teratogenic effects in the first trimester</p> Signup and view all the answers

    What is the primary reason for advising people with peptic ulcers to avoid naproxen?

    <p>Known sensitivity to tNSAIDs</p> Signup and view all the answers

    What is the primary concern regarding naproxen use in breastfeeding mothers?

    <p>Passage of significant doses to the newborn</p> Signup and view all the answers

    What is the primary similarity in drug interactions between naproxen and diclofenac?

    <p>Both have an antiplatelet effect</p> Signup and view all the answers

    Why should other anticoagulants and antiplatelet drugs be avoided with naproxen?

    <p>They have similar drug interactions</p> Signup and view all the answers

    What is the primary concern regarding NSAID use near term?

    <p>Association with cardiac defects</p> Signup and view all the answers

    What is the primary effect of naproxen on premature ductal closure?

    <p>It accelerates the process</p> Signup and view all the answers

    What is the primary reason for avoiding NSAIDs in people with known sensitivity to tNSAIDs?

    <p>Potential adverse reactions</p> Signup and view all the answers

    What is the primary reason for avoiding NSAIDs near term?

    <p>Risk of intracranial hemorrhage in the newborn</p> Signup and view all the answers

    What is the primary effect of naproxen on breast milk?

    <p>It is excreted in small doses to the newborn</p> Signup and view all the answers

    Which type of local anesthetic is primarily hepatically metabolized and has a slower breakdown?

    <p>Procaine</p> Signup and view all the answers

    What is the primary difference between epidural anesthesia and subarachnoid anesthesia?

    <p>Site of injection</p> Signup and view all the answers

    What is the maximum duration of blockade for chloroprocaine?

    <p>45 minutes</p> Signup and view all the answers

    What triggers the vomiting reflex?

    <p>Stimulation of the vomiting centre</p> Signup and view all the answers

    What is the primary similarity in drug interactions between naproxen and diclofenac?

    <p>Both interact with antiplatelet drugs</p> Signup and view all the answers

    What is the onset of action for bupivacaine in minutes?

    <p>10-20 minutes</p> Signup and view all the answers

    What is a potential danger associated with nitrous oxide (ENTONOX) use in labor?

    <p>Respiratory depression</p> Signup and view all the answers

    Which local anesthetic was removed from the Canadian market in 2012?

    <p>Chloroprocaine</p> Signup and view all the answers

    What is a key characteristic of chronic pain?

    <p>Long-term nature</p> Signup and view all the answers

    What is the primary mode of action of diclofenac?

    <p>COX-2 inhibition</p> Signup and view all the answers

    What is a potential consequence of high plasma levels of local anesthetics?

    <p>Seizures and coma</p> Signup and view all the answers

    What is the result of fear or nervousness during local anesthesia administration?

    <p>Vasovagal collapse</p> Signup and view all the answers

    What are the initial symptoms of systemic toxicity from local anesthetics?

    <p>Ringing in the ears</p> Signup and view all the answers

    What may lead to a reduction in circulating blood volume during local anesthesia administration?

    <p>All of the above</p> Signup and view all the answers

    What may occur at higher concentrations of local anesthetics in the central nervous system?

    <p>All of the above</p> Signup and view all the answers

    What is the primary concern regarding bupivacaine use in combination with chloroprocaine?

    <p>Increased likelihood of seizures</p> Signup and view all the answers

    What may lead to temporary shortness of blood flow to the brain during local anesthesia administration?

    <p>Dilation of arteries in muscles</p> Signup and view all the answers

    What are the symptoms of vasovagal collapse during local anesthesia administration?

    <p>Visibly looking pale and perspiration</p> Signup and view all the answers

    What may occur at very high tissue concentrations of local anesthetics?

    <p>Coma, respiratory arrest, and death</p> Signup and view all the answers

    What may result from the anticipation of pain during local anesthesia administration?

    <p>All of the above</p> Signup and view all the answers

    What is a localized side effect of local anesthesia?

    <p>Tissue swelling</p> Signup and view all the answers

    For what purpose is conduction anesthesia preferred over analgesics?

    <p>Superior pain control</p> Signup and view all the answers

    What is a risk associated with local anesthesia?

    <p>Temporary or permanent nerve damage</p> Signup and view all the answers

    What is the primary reason for combining conduction anesthesia with general anesthesia or sedation for surgeries?

    <p>To anesthetize virtually every part of the body</p> Signup and view all the answers

    What is the typical recovery period for nerve damage after a peripheral nerve block?

    <p>Rare, with symptoms likely to resolve within a few weeks</p> Signup and view all the answers

    What are the general systemic adverse effects of local anesthesia due to?

    <p>Pharmacological effects of the anesthetic agents</p> Signup and view all the answers

    What is the duration of soft tissue anesthesia compared to pulpal anesthesia?

    <p>Longer</p> Signup and view all the answers

    What is the primary risk associated with the use of local anesthesia in patients with liver disease?

    <p>Significant consequences</p> Signup and view all the answers

    What is the primary reason for using local anesthesia in diagnostic tests such as bone marrow aspiration and lumbar puncture?

    <p>To reduce pain</p> Signup and view all the answers

    What is a potential consequence of accidental damage to blood vessels during local anesthesia?

    <p>Tissue necrosis</p> Signup and view all the answers

    Study Notes

    Anesthesia and Pain Management in Labor

    • Specific pain nerve fibers in tissues are stimulated by inflammatory mediators like histamine and PGs released when tissues are damaged
    • NSAIDs block PG synthesis, impeding the passage of pain impulses that depend on action potentials
    • Opioids act in the dorsal horn of the spinal cord, which integrates pain and touch fibers and descending messages, known as the "pain gate"
    • Pain pathways in the brainstem activate the sympathetic nervous system, increasing respiration, heart rate, blood pressure, emesis, and perspiration
    • The first stage of labor is mostly visceral, caused by dilation of the cervix and distention of the lower uterine segment
    • The second stage of labor is mostly somatic, caused by the distention of the pelvic floor, vagina, and perineum as the baby pushes down
    • Approximately 64% of women in labor at Ontario hospitals will have some form of regional anesthesia, with most receiving epidural or intrathecal ("spinal") anesthesia
    • Regional anesthesia at the level of the lumbar spine affects the sympathetic nervous system, as part of the SNS emerges from the lumbar spine
    • The spinal cord ends at L1, and below L1, the spine continues as spinal nerves called the cauda equina
    • Epidural anesthesia involves the injection of a drug into the fat-filled epidural space, anesthetizing whatever peripheral nerves are in contact with the drug
    • Subarachnoid anesthesia is often called a "spinal" or intrathecal injection, providing clear endpoints and working faster than epidural anesthesia
    • Opiates work in various locations in the central and peripheral nervous systems, binding to opiate receptors on the free nerve endings to decrease firing of nerves

    Management of Nausea and Vomiting in Pregnancy, and Postpartum Pain Control

    • Nausea and vomiting of pregnancy (NVP) affects 3-2% of pregnancies and can progress to hyperemesis gravidarum (HG).
    • DICLECTIN, a drug used in Canada, is the first-line therapy for NVP and is a combination of doxylamine succinate and pyridoxine hydrochloride.
    • DICLECTIN acts as a histamine antagonist that binds to histamine type 1 receptors, preventing histamine from binding and inhibiting the action of histamine.
    • DICLECTIN tablets have a special coating for delayed release and contain 10mg of doxylamine and 10mg of pyridoxine, with a typical dosing of 4 tablets a day.
    • Adverse reactions of DICLECTIN include drowsiness, stomach upset, diarrhea, and headache, and caution is advised when taken concurrently with alcohol or by clients with epilepsy.
    • Symptoms of DICLECTIN overdose include restlessness, dry mouth, dilated pupils, sleepiness, dizziness, mental confusion, and rapid heartbeat, and treatment involves gastric lavage or activated charcoal.
    • Postpartum pain can be acute or chronic, classified as visceral or somatic, and may include afterpains, perineal or vaginal lacerations, postoperative pain, and breast engorgement.
    • NSAIDs like diclofenac and naproxen are used for postpartum pain control, with diclofenac being a prescription-only analgesic in Canada and more specific for COX2 than COX1.
    • Diclofenac is metabolized by the liver, has a half-life of about 3 hours, and is used for post-surgical pain relief and inflammation, especially for perineal pain and swelling.
    • Adverse effects of diclofenac include excretion in breast milk, caution in clients with cardiovascular disease, and it should not be given to individuals with midwifery legislation.
    • Naproxen, another NSAID used for postpartum pain, is available in over-the-counter and prescription doses, metabolized mainly by the liver, and has a half-life of about 14 hours.
    • Adverse effects of naproxen include excretion in breast milk, contraindication in pregnancy, and caution in clients with hypertension.

    Local Anesthetics and Naproxen Drug Interactions

    • Naproxen has an antiplatelet effect, so it should be avoided with other anticoagulants and antiplatelet drugs like ibuprofen and ASA
    • Midwifery legislation has no significant interactions with modest doses of naproxen for post-partum pain control
    • Ibuprofen has a half-life of 2 hours, while naproxen has a half-life of 14 hours for post-partum pain
    • Local anesthetics work by blocking open sodium channels and are used in various forms including topical, infiltrational, field block, nerve block, and regional
    • Common local anesthetics for perineal repair include lidocaine, bupivacaine, and chloroprocaine, which belong to different classes of local anesthetics
    • Amide local anesthetics are primarily hepatically metabolized and have a slower breakdown, while ester local anesthetics are rapidly broken down in the blood by esterases
    • Ester local anesthetics have short half-lives and provide anesthesia for less than 30 minutes, while amide local anesthetics last longer
    • Local anesthetics block different types of nerves including C fibers, thin and unmyelinated, B fibers, thin and myelinated, A-delta fibers, and A-alpha fibers
    • Bupivacaine has an onset of action in 5-10 minutes and provides pain control for about 2X longer than lidocaine and 3X longer than chloroprocaine
    • Bupivacaine toxicity includes cardiac arrest and ventricular arrhythmia, with the onset of a toxic reaction often preceded by tongue paresthesia and light-headedness
    • Chloroprocaine, sold as Nesacaine, has an onset of action in 3-5 minutes with a maximum duration of blockade of about 30-60 minutes and was removed from the Canadian market in 2012
    • Pain pathways are complex, involving different types of nerves and sensitivities to local anesthetics, which have varying onset of actions and durations of blockade

    Pain Pathways and Management in Labor

    • Somatic pain arises from skin, subcutaneous tissues, and mucous membranes and is well localized with sharp, pricking, throbbing, or burning sensations.
    • Deep somatic pain comes from muscles, tendons, joints, or bones and has a dull, aching quality, often associated with autonomic responses.
    • Labour pain mainly involves acute visceral pain, with signals traveling via sympathetic nerves to specific spinal cord segments.
    • Acute somatic pain in labor is associated with cervix stretching and tearing in the perineum, while visceral pain is mainly through specific spinal segments.
    • Postpartum pain can result from afterpains, perineal or vaginal lacerations, and breast engorgement, usually responding to mild analgesics or nonpharmacologic interventions.
    • Diclofenac, a prescription medication, inhibits both COX-1 and COX-2 and is mainly metabolized by the liver, with about 65% of its metabolites excreted in the urine.
    • Diclofenac has adverse effects such as GI distress, long-term use associated with an increase in serum liver enzymes, and is not recommended during early or late pregnancy due to potential fetal complications.
    • Diclofenac is not recommended for people with peptic ulcers and known sensitivity to tNSAIDs, and should be avoided with other anticoagulants and antiplatelet drugs.
    • Naproxen, a tNSAID available over the counter, is not as specific for COX-2 as diclofenac, with a half-life of about 14 hours and similar side effects to diclofenac.
    • Naproxen is rapidly absorbed, metabolized in the liver, and excreted as a urinary metabolite, with peak serum levels reached in two to four hours depending on the form of administration.
    • Long-term use of naproxen may lead to GI side effects such as dyspepsia, nausea, heartburn, and abdominal pain, similar to other tNSAIDs.
    • Both diclofenac and naproxen are commonly used for postpartum pain management, with differences in specificity, metabolism, excretion, and adverse effects.

    Pain Pathways and Management in Labor

    • Somatic pain arises from skin, subcutaneous tissues, and mucous membranes and is well localized with sharp, pricking, throbbing, or burning sensations.
    • Deep somatic pain comes from muscles, tendons, joints, or bones and has a dull, aching quality, often associated with autonomic responses.
    • Labour pain mainly involves acute visceral pain, with signals traveling via sympathetic nerves to specific spinal cord segments.
    • Acute somatic pain in labor is associated with cervix stretching and tearing in the perineum, while visceral pain is mainly through specific spinal segments.
    • Postpartum pain can result from afterpains, perineal or vaginal lacerations, and breast engorgement, usually responding to mild analgesics or nonpharmacologic interventions.
    • Diclofenac, a prescription medication, inhibits both COX-1 and COX-2 and is mainly metabolized by the liver, with about 65% of its metabolites excreted in the urine.
    • Diclofenac has adverse effects such as GI distress, long-term use associated with an increase in serum liver enzymes, and is not recommended during early or late pregnancy due to potential fetal complications.
    • Diclofenac is not recommended for people with peptic ulcers and known sensitivity to tNSAIDs, and should be avoided with other anticoagulants and antiplatelet drugs.
    • Naproxen, a tNSAID available over the counter, is not as specific for COX-2 as diclofenac, with a half-life of about 14 hours and similar side effects to diclofenac.
    • Naproxen is rapidly absorbed, metabolized in the liver, and excreted as a urinary metabolite, with peak serum levels reached in two to four hours depending on the form of administration.
    • Long-term use of naproxen may lead to GI side effects such as dyspepsia, nausea, heartburn, and abdominal pain, similar to other tNSAIDs.
    • Both diclofenac and naproxen are commonly used for postpartum pain management, with differences in specificity, metabolism, excretion, and adverse effects.

    Uses and Side Effects of Local Anesthesia

    • Local anesthesia is used in various techniques including topical administration, infiltration, brachial plexus block, epidural block, spinal anesthesia, iontophoresis, diagnostic purposes, and as anti-arrhythmic agents.
    • Conduction anesthesia may be preferred for managing acute pain due to its superior pain control and fewer side effects compared to analgesics.
    • Local anesthetics are also applied repeatedly or continuously for prolonged periods to relieve chronic pain, often in combination with other medications.
    • Virtually every part of the body can be anesthetized using conduction anesthesia, and it is sometimes combined with general anesthesia or sedation for surgeries.
    • Local anesthesia is used to reduce pain in diagnostic tests such as bone marrow aspiration, lumbar puncture, and aspiration of cysts.
    • It is also used during the insertion of IV devices, for enabling painless venipuncture, and for facilitating certain endoscopic procedures.
    • Localized side effects of local anesthesia include tissue swelling, blanching of tissues, and longer duration of soft tissue anesthesia.
    • Risks associated with local anesthesia include temporary or permanent nerve damage, accidental damage to blood vessels, and significant consequences when administered to patients with liver disease.
    • Recovery from nerve damage after a peripheral nerve block is rare, with symptoms likely to resolve within a few weeks.
    • General systemic adverse effects of local anesthesia are due to the pharmacological effects of the anesthetic agents used.
    • The duration of soft tissue anesthesia is longer than pulpal anesthesia and is often associated with difficulty eating, drinking, and speaking.
    • The risk of temporary or permanent nerve damage varies between different locations and types of nerve blocks.

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    Test your knowledge of anesthesia and pain management in labor with this quiz. Learn about the mechanisms of action of NSAIDs and opioids, the stages of labor, and the use of regional anesthesia such as epidural and intrathecal injections.

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