Page 135 Guide to Pain Management in Low-Resource Settings

Chapter 17

Pharmacological Management of Pain in Obstetrics

Katarina Jankovic

Case report Systemic administration includes the intravenous, in-
tramuscular, and inhalation routes. Regional techniques
Charity, a 28-year-old offi ce worker living in Nyeri, ar- are comprised of spinal and epidural anesthesia. Epidu-
rives late one evening at Consolata Hospital. She is in ral anesthesia has gained popularity in the last decade
her fi rst pregnancy and is accompanied by her mother and has almost replaced systemic analgesia in many
Jane, an experienced mother who thought it would be obstetric departments, mostly in developed countries.
about the right time to see the obstetrician, since Char- Regional techniques are widely acknowledged to be the
ity’s contractions had become more and more regular. only consistently eff ective means of relieving the pain
On admission, Charity says she would like to try to go of labor and delivery, with signifi cantly better analgesia
through the labor without pain killers, but as contrac- compared to systemic opioids.
tions become stronger, she starts screaming for help.
What could you do to relieve the pain?
What are the advantages
of systemic analgesics?
Do all women in labor have pain
that requires analgesic treatment? Systemic analgesics may be administered by individu-
als who are not qualifi ed to perform epidural or spinal
Th e pain of labor and delivery varies among women, blocks, and so they are often used in situations when an
and even for an individual woman, each childbirth may anesthesiologist is not available. Th ey also are useful for
be quite diff erent. As an example, an abnormal fetal pre- patients in whom regional techniques are contraindicat-
sentation, such as occiput posterior, is associated with ed. Th e most popular agents are opioids (e.g., morphine,
more severe pain and may be present in one pregnancy, fentanyl, butorphanol, pethidine [meperidine], and tram-
but not the next. It may be estimated that one in four adol). While the sedative side eff ects of opioids are gener-
women in labor require analgesia. ally unwanted and irritating for the patient, in the labor-
ing woman sedation induces relief and general relaxation.
What are the application routes Analgesic eff ects sometimes appear to be secondary.
for analgesia if needed? A systematic review of randomized trials of
parenteral opioids for labor pain relief was able to
Pharmacological approaches to manage childbirth pain show that satisfaction with pain relief provided by
can be broadly classifi ed as either systemic or regional. opioids during labor was low, and the analgesia from
Guide to Pain Management in Low-Resource Settings, edited by Andreas Kopf and Nilesh B. Patel. IASP, Seattle, © 2010. No responsibility is assumed by IASP 123
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