Best treatment for relieving pain during intrapartum period is:
Ans: B (Epidural anesthesia) Ref: Ajay Yadav Short Textbook of Anesthesia,1st edition, pg 123Explanation:Epidural (Extradural) anesthesiaThe epidural space is a potential space.It contains connective tissue, venous plexuses, and adipose tissue.It is found between the connective tissue covering the vertebrae and the ligamentum flavum posteriorly and the dura mater anteriorly.Laterally it is bound by the pedicles and the intervertebral foramina.It extends from the foramen magnum, where the dura is fused to the base of the skull, to the sacral hiatus.The plica mediana dorsalis is a connective tissue hand that may extend from the dura mater to the ligamentum flavum. which divides the posterior epidural space into right and left compartments.Clinically, this is significant because it may affect the spread of epidurally injected medications.IndicationsAll surgeries which can be performed under spinal anesthesia can he performed under epidural blockPlus upper abdominal surgeries, thoracic surgeries and even neck surgeries can be performed under cervical epidural blockMainly used for controlling postoperative painFor painless labourTo control chronic pain due to cancer and chronic pain conditionsAcute occlusive vascular conditionsBlood patch for posispinal headacheSite of action of drugAnterior and posterior nerve rootsMixed spinal nervesDrug diffuses through dura and arachnoid and inhibits descending pathways in spinal cordComplicationsInadequate patch blockHypotensionApnea (higher blocks)Total spinal: Accidental injection into subarachnoid space - presents with marked hypotension, bradycardia, apnea, dilated pupils and comaDural punctureIn vascular injectionLocal anesthetic toxicityHorner's syndrome (Cervical block)Epidural hematomaEpidural abscessAnterior spinal artery syndromeNeedle injury to spinal cordEpiduro-cuteaneous fistulaTrigeminal nerve palsyIntraocular hemorrhageOther methods tried in Obstetric analgesia -Regional nerve blocksSubarachnoid (Spinal) anesthesiaPudendal nerve block
Neuraxial block
Epidural anesthesisa
IV ketamine
General Anesthesia
Anaesthesia For Special Situations