Anesthesia services: Pain Relief for Children

Good pain relief during labor and delivery enables you to be more comfortable and to more effectively participate in the birth of your baby.

The degree of discomfort experienced during labor and delivery varies from patient to patient and from one labor experience to the next. Some women do very well with techniques such as Lamaze, while most request further assistance and thereby use a combination of techniques. Depending upon your labor pattern, labor progress, medical history and your baby’s condition, additional pain management might include intravenous (I.V.) medications or epidural analgesia.

The vast majority of women in labor prefer to have epidural analgesia because of the excellent pain relief a long history of safety for both mother and baby. Remember, the choice of analgesia is a decision determined by you and your health care team (anesthesiologist, obstetrician, nurse anesthetist, nurse).

Epidural Analgesia

The epidural space runs the length of your back and is located just outside the sac that contains the spinal cord, nerves, and spinal fluid. A tiny catheter placed in the epidural space in the small of your back (the lumbar region) allows the administration of pain control medications before, during and after your delivery. Epidural analgesia is often more effective than other forms of pain management following certain types of procedures, and your anesthesiologist will explain this method more thoroughly if it is indicated.

Potential Risks of Epidural Analgesia/Anesthesia
We are very proud of our excellent obstetrical anesthesia track record of safety and concern for mother and baby. Though serious side effects occur infrequently, we are fully prepared to handle any situation. It is important to note that in almost every situation, the advantages of pain relief during childbirth greatly outweigh the potential risks.

A catheter bumping against a nerve can cause a brief “funny bone” sensation, but nerve injury related to an epidural is exceedingly rare. Most patients have a backache after childbirth whether or not they have had an epidural.

Sometimes, patients will have “breakthrough pain” and will require an additional does of medications or occasionally, the epidural may need to be replaced. Communicating with your care provider is very important in obtaining the most responsive pain management.

Other very uncommon events might involve some medication entering a blood vessel or the spinal fluid sac. If the epidural needle or catheter enters the spinal fluid sac, the patient may get a headache 24 to 48 hours later. We have effective treatments for this problem.

Anesthesia For Cesarean Section
There are two types of anesthesia used for Cesarean sections: regional or general anesthesia. A recommendation will be made by your anesthesiologist after a thorough review is conducted of you and your baby’s medical condition. Both methods of anesthesia have a long history in obstetrics, and although there are risks, they have been shown to be safe for you and your baby.

Regional anesthesia is an attractive choice because you can be awake during your baby’s birth and your support person can join you in the operating room. Also, your baby’s exposure to medications is reduced and the potential risks of general anesthesia can be avoided.

Regional anesthesia is administered using one of two techniques: epidural or spinal anesthesia. If you already have an epidural catheter in place from labor, stronger anesthetic medications will be given to establish anesthesia for your Cesarean section. Once the epidural or spinal anesthetic becomes effective, you will be numb from your mid-chest to your toes.  Your legs may seem heavy and you will not be able to move them until after the anesthetic wears off. You also may feel some tugging, pulling or pressure as the bay is born, but you should not feel pain.

An alternative to epidural anesthesia is spinal anesthesia, which involves injecting a local anesthetic into the spinal fluid sac. Receiving a spinal anesthetic is very similar to receiving an epidural anesthetic. You can discuss the relative risks and benefits of spinal or epidural anesthesia for Cesarean section with your anesthesia provider.

Occasionally it is necessary to use general anesthesia. To minimize your baby’s exposure to anesthetic agents, your abdomen will be cleansed and draped before you go to sleep. Medication will be injected through your I.V. to induce general anesthesia. After you are asleep, a special breathing tube will be placed into your mouth to reduce the risk of aspiration of stomach contents. After the tube is in place, the surgery begins. After the surgery is completed, the breathing tube will be removed and you will be transformed to the recovery room for observation. A sore throat is an occasional complaint following surgery.

Post C-Section Pain Management
Atlantic Anesthesia Post-Operative Pain Management Service offers personalized options techniques for post-op pain management. These include options for allowing you to use computerized patient-controlled relief systems. Most often, narcotics such as Duramorph or Astramorph can be given painlessly via the epidural catheter o with a spinal anesthetic. One dose can provide pain relief for 12 to 24 hours, allowing patients to get out of bed and walk the same day as their surgery. The pain relief tends to be constant, thereby avoiding the peaks and valleys that are associated with traditional “shots”.

Patient-Controlled Analgesia, or PCA, uses a computer-programmed pump filled with pain medication which is connected to your I.V. bag. You press a button to receive a safe amount of medicine by vein whenever you are in pain. This provides more rapid relief of pain because you are able to control the timing of you medication.

As with any narcotic, occasional side effects may occur including itching, nausea and, very rarely, slowing of your breathing. These are usually mild and easily managed.

No narcotic given by any method totally eliminates pain, but epidural/spinal narcotics and PCA are usually far more effective than “shots” in decreasing post-surgical pain to a tolerable level. Either option is safe for your baby if you are breast feeding.

FAQs

What is an anesthesiologist?
An anesthesiologist is a doctor of medicine who has completed four years of medical school after graduating from college. Following medical school, today’s anesthesiologist completes four or more years of specialized medical training in the field of anesthesiology which includes pain management and critical care medicine. Subspecialty fellowships can also be completed for subspecialty board certification.

What is a CRNA?
A CRNA, or Certified Registered Nurse Anesthetist (also referred to as a nurse anesthetist) is a Masters degree-prepared, advanced-practice nurse who has graduated from an accredited school of nurse anesthesia. CRNAs have the education and advanced skills to administer anesthetics under the supervision of Atlantic Anesthesia’s physician anesthesiologists.

What type of anesthesia am I going to have?
Each woman’s labor is unique to her. The amount of labor pain you may feel depends on a variety of factors such as your level of pain tolerance, the size and position of the baby, strength of uterine contractions, (anesthesiologists, obstetrician, nurse anesthetist, nurse) will review your medical conditions with you in order to determine the most appropriate anesthetic plan for your labor and delivery.

How will my medications interact with the anesthesia?
Few medications interact significantly with regional or general anesthesia. Your anesthesiologist will review your medications with you and advise you of any necessary changes to your anesthetic plan.

Can I eat or drink anything while in labor?
Any time anesthesia may be required, an empty stomach is preferred to decrease the risks associated with vomiting. Digestion of food slows significantly during labor. Oral intake should be limited to clear liquids while you are at home. Once you decide to come to the hospital or our obstetrician instructs you to come to the hospital, do not eat or drink anything until you have been admitted and evaluated on the labor/delivery unit. During labor, ice ships and available.

What if I have significant medical problems or have had problems related to anesthesia in the past?
Bring these problems to the attention of your obstetrician who will contact our group well in advance of your admission. Sometimes, a patient is asked to meet with anesthesiologist before her due date to coordinate any special tests or additional consultation between our obstetrician and one of our anesthesiologists is sufficient.

At what point may I have epidural?
The decision to provide analgesia will be made jointly by you and your obstetrical and anesthesia care teams. Our anesthesia group feels that no time is absolutely too early to too late to provide pain relief. However, before beginning an anesthetic, we will insist that you be examined by an obstetrician at least once following the onset of your labor. The above policy may be waived if we have knowledge that your obstetrician is on the way to examine you.

How soon will the epidural block take effect?
Most patients will notice a significant reduction in labor pain within 20 minutes of epidural catheter placement. Your anesthesia care team will ensure you are given relief from your epidural before completing the procedure.

How long will the block last?
Epidural catheters can safely remain in place for the duration of your labor delivery. The effects of the medicine may last several hours.

Will an epidural alter the duration of labor?
Occasionally, if epidural analgesia is started very early, labor might slow for a very short period of time, but more often, epidural analgesia shortens labor because the patient is more relaxed and the baby comes down easier.

When is general anesthesia used?
When regional anesthesia is unsafe, or when your or your baby’s medical conditions preclude the time and positioning necessary for an epidural or spinal, your anesthesiologist will administer general anesthesia for a Cesarean section. General anesthesia may also be used if your regional anesthetic is inadequate for a Cesarean section. General anesthesia is not used for vaginal deliveries.

Can I contact an anesthesiologist directly?
If you would like to speak directly to one of our anesthesiologists, call 757-388-4871 between 9:00 a.m. and 4:30 p.m. if you will be delivering at Sentara Norfolk General Hospital or Sentara Leigh Hospital. For Sentara Virginia Beach General Hospital, call 757-395-6769 between 8 a.m. and 3:30 p.m. Following this conversation, if you would like to meet personally with an anesthesiologist, we will schedule an appointment for you.

Billing
Most physicians, including your anesthesiologist, are in private practice; that is, they are not hospital employees. Therefore, you will receive a separate statement from your other physicians. The hospital bill will include charges for hospital supplies used in the administration of your anesthesia.