| Types | Characteristics | Nursing Implications |
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Common Agents in 0.5-1.0% Solution Lidocaine (Xylocaine) Bupivacaine (Marcaine) HCl Tetracaine (Pontocaine) HCl Mepivacaine HCl (Carbocaine) Chloroprocaine HCl (Nesacaine) |
Used with epinephrine (or other vasoconstrictor drug) to delay absorption, prolong anesthetic effect, and decrease chance of hypotension | Note any history of allergy; note response: allergic reaction, hypotension, and lack of wearing off of anesthetic effect; observe for hypertensive crisis if agent combined with epinephrine and oxytocin is also being given |
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Peripheral Nerve Block Pudendal (5 - 10 milliliter each side) anesthetizes two - thirds of vagina and perineum |
Perineal anesthesia of short duration (30 min); local anesthesia; simple and safe; does not depress neonate; may inhibit bearing - down reflex | To get cooperation, give explanation during procedure |
| Paracervical (uterosacral) block (5 - 10 mL given into each side) anesthetizes cervix and upper two - thirds of vagina; note: used more for gynecological surgery than labor | May be given between 3 and 8 cm by physician when woman is having at least three contractions in 10 min; lasts 45 - 90 min; can be repeated; can be followed by local, epidural, or other; may cause temporary fetal bradycardia | Explain: especially length and type of needle; take maternal vital signs and FHR; have her void; help position; monitor FHR continuously; monitor contractions; and watch for return of pain |
| Local infiltration | Useful for perineal repairs | No special nursing care |
| Epidular Lumbar Block | Useful during first and second stages; can be given “one shot” or continuously; T - 10 to S - 5 for vaginal birth; T - 8 to S - 1 for abdominal birth; complete anesthesia for labor and birth | Hypotension (with resultant fetal bradycardia): (a) turn from supine to lateral, or elevate legs, (b) administer humidified oxygen by mask at 8 - 10 L/min, (c) increase rate of IV fluids (use infusate without oxytocin); will need coaching to push and low forceps may be required |
| Subarachnoid spinal Continuous | Useful during first or second stage of labor, or for abdominal surgery | Instruct when to bear down |
| Low spinal (“saddle,” “one shot”) block | Same as continuous | Same as continuous |
| Intrathecal (spinal): morphine, fentanyl, Sufentanil |
0.5 mg produces marked analgesia for 12 - 24 hr; onset in 20 - 30 min Fentanyl and Sufentanil produce short - acting analgesia |
Side effects: respiratory depression, pruritus, nausea, vomiting, sleepiness, urinary retention; keep naloxone 0.4 mg at beside and respiratory support equipment available |