Pain Management Archives - obsgynaecritcare

Hi everyone

Dexmedetomidine, is both a difficult word to pronounce correctly in casual conversation but also a useful pharmacological tool in many different situations.

This week I am joined by one of our fellows Dr Han Lu to discuss dexmedetomidine, it’s history, it’s basic pharmacology and then more specifically it’s use in different clinical situations where it may be useful in obstetrics and gynaecology.

Thanks Han for a great Tuesday talk and a very informative podcast!

Han’s powerpoint talk

Effectiveness of dexmedetomidine on patient-centred outcomes in surgical patients: a systematic review and Bayesian meta-analysis. BJA September 2024

Crowe. G, et al Perioperative Applications of Dexmedetomidine. ATOTW 469 — Perioperative Applications of Dexmedetomidine April 2022

Douglas MS, Soloniuk LJ, Jones J, Derderian R, Baker C, Stier G. Intravenous dexmedetomidine use in obstetric anesthesia: a focused review. Int J Obstet Anesth. 2025 May;62:104345. doi: 10.1016/j.ijoa.2025.104345. Epub 2025 Feb 13. PMID: 40090158

Atipamezole – alpha 2 agonist reversal agent used in veterinary practice

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Hi everyone,

This week Declan and I sit down to discuss a novel non opioid analgesic drug recently approved for use by the FDA, suzetrigine.

What is it? How does it work? Why should we be interested in this new class of drugs and most importantly will it live up to it’s hype?

Suzetrigine: First in a New Class of Nonopioid Analgesics for Acute Pain. Anesthesiology 142(6):p 989-991, June 2025. | DOI: 10.1097/ALN.0000000000005465 – Unfortunately this is not a free article but well worth a read if you can get to it through your hospital or college library. The accompanying podcast of this editorial is open access – follow the following link. podcast

Suzetrigine Drug-Drug Interactions: Perioperative Anesthesia Considerations to Enhance Patient Safety

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Your patient arrives in the anaesthetic room next to theatre, she’s booked for a non elective caesarean for failure to progress. She has an epidural in situ and you decide try to top it up – however after 25ml of lignocaine 2% with adrenaline and around 20min of waiting the block is stuck at the umbilicus and she can still move her legs relatively freely. This is obviously not going to be adequate – she is adamant she wants to be awake to see her baby born. You sit her up, pull out the epidural and do a single shot spinal with 2.1ml of heavy bupivacaine 0.5% + fentanyl 15mcg – after all you don’t want this block to fail as well!

You clean her back, lie her down and turn to talk to the midwife. When you turn back to the patient 30s later she looks a little purple and isn’t breathing…….

Hi everyone join Graeme and I this week as we discuss total spinal anaesthesia – a fascinating but somewhat scary rare emergency which can occur when we use regional anaesthesia in obstetric practice.

A big shout out to the team from Rotunda Hospital in Dublin who wrote the recent narrative review published in IJOA on this topic!

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Hi Everyone,

Join Siv and I as we sit down to discuss a couple of interesting obstetric related topics. The first is the pharmacology around the choice and strength of local anaesthetics used in epidural analgesia – thanks Siv. The second part we discuss a very large pragmatic study in the New England Journal of Medicine of 11000 women studying the use of tranexamic acid as a prophylaxis during caesarean surgery (elective and emergency). Spoiler alert it didn’t show any difference (death or transfusion).

Thanks Siv!

Tranexamic Acid to Prevent Obstetrical Hemorrhage after Cesarean Delivery Pacheo et al N Engl J Med 2023; 388:1365-1375

Minimum local analgesic concentration of local anaesthetics. Malachy Columb, Iain Gall Continuing Education in Anaesthesia Critical Care & Pain, Volume 10, Issue 4, August 2010, Pages 114–116

Determination of the Minimum Local Analgesic Concentrations of Epidural Bupivacaine and Lidocaine in Labor. Columb, Malachy O. FRCA; Lyons, Gordon FRCA. Anesthesia & Analgesia 81(4):p 833-837, October 1995.

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Hi Everyone,

In our tertiary women’s hospital here in Perth we use remifentanil PCA in labour approximately 15 times a year – and we are told that in Australian terms this is considered a “heavy user” of this labour analgesic technqiue.

This week I sit down with Mike Jamison an anaesthetic fellow from Belfast spending a year with us here in Perth. When he arrived in WA we quickly learned from him that remifentanil PCA is commonly used for labour analgesia in Northern Ireland with one unit he worked in having prescribed this technique for more than 11,000 women. We sit down to have a deep dive into the use of remifentanil PCA in labour in Northern Ireland. What aspects of their approach have led it to become such a commonly utilised technique? What is their recipe? How do they prescribe it, how do they monitor the women and how is this technique now viewed amongst the obstetric, midwifery and wider Northern Irish community!

If you are attending the upcoming Obstetric Anaesthesia satellite meeting in Sydney in a few weeks – come along to hear Mike talk on this in person!

Intravenous remifentanil patient-controlled analgesia versus intramuscular pethidine for pain relief in labour (RESPITE): an open-label, multicentre, randomised controlled trial. The Lancet volume 392, p662-672, AUGUST 25, 2018

Remifentanil patient-controlled intravenous analgesia during labour: a retrospective observational study of 10 years’ experience. H Murray, P Hodgkinson, D Hughes. Int J Obstet Anesth 2019 Aug;39:29-39

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Hi everyone,

This week Graeme and I sit down for the first time in nearly a year and do a bit of a deep dive on the use of nitrous oxide as an analgesic in labour. We drop a few dad jokes, discuss the history of inhaled analgesics, nitrous oxide use around the world, the evidence, the environmental concerns and other interesting anecdotes.

Do you have nitrous oxide on labour ward in your part of the world? Send us a comment and let us know!

Enjoy

ANZCA Blue Book 2021 (Australasian Anaesthesia) – go to page 183

Developments in labour analgesia and their use in Australia 2015

Safety and Utility of Nitrous Oxide for Labor Analgesia APSF Journal June 2020

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Hi everyone,

This week Sneha leads a discussion with both Matt and myself where we take a deep dive into how to actually perform an epidural blood patch. Even though you can’t really classify this as an uncommon procedure, as individuals we probably don’t do very many and it is hard for most of us to become experienced and “expert” (whatever that is defined as).

We discuss the evidence, the effectiveness, the practical considerations and some of the common problems / difficulties which may be encountered.

Thanks Sneha (for organising and leading this episode) and of course you too Matt!

Epidural blood patch: A narrative review – Anaesthesia Critical Care & Pain Medicine October 2022

Treatment of obstetric post-dural puncture headache. Part 2: epidural blood patch International Journal of Obstetric Anesthesia 2019

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Welcome to this podcast, the four in our series of obstetric anaesthesia basics. Join us for this conversation where we discuss the approach to a woman with a suspected or known post dural puncture headache. This follows our previous discussion of the incidence, significance and management of accidental dural punctures & intrathecal catheters, which you may want to listen to prior to this episode.

Thanks Laura, Matt & Roger!

The “Basics of Obstetric Anaesthesia” is a short series of podcasts, where we aim to discuss in a conversational manner the basic topics you will need to understand if you wish to practice obstetric anaesthesia. These will be especially useful to anaesthesia trainees new to obstetric anaesthesia but also may appeal to experienced practitioners wanting a refresher of the basics in this subspecialty area.

1 – Epidural analgesia in labour part 1

2 – Epidural analgesia in labour part 2, pitfalls and troubleshooting

3 – Accidental dural puncture and intrathecal catheters

4 – Post-dural puncture headaches and management

5 – Pre-eclampsia, eclampsia and hypertensive disorders

6 – General anaesthesia for Caesarean Delivery part 1

7 – General anaesthesia for Caesarean Delivery part 2

8 – Obstetric Haemorrhage

9 – Neuraxial anaesthesia for Caesarean Delivery

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Welcome to this podcast, the third in our series of obstetric anaesthesia basics. Join us for this conversation where we discuss the incidence, significance and management of accidental dural punctures & intrathecal catheters.

Thanks Laura, Matt & Roger!

The “Basics of Obstetric Anaesthesia” is a short series of podcasts, where we aim to discuss in a conversational manner the basic topics you will need to understand if you wish to practice obstetric anaesthesia. These will be especially useful to anaesthesia trainees new to obstetric anaesthesia but also may appeal to experienced practitioners wanting a refresher of the basics in this subspecialty area.

1 – Epidural analgesia in labour part 1

2 – Epidural analgesia in labour part 2, pitfalls and troubleshooting

3 – Accidental dural puncture and intrathecal catheters

4 – Post-dural puncture headaches and management

5 – Pre-eclampsia, eclampsia and hypertensive disorders

6 – General anaesthesia for Caesarean Delivery part 1

7 – General anaesthesia for Caesarean Delivery part 2

8 – Obstetric Haemorrhage

9 – Neuraxial anaesthesia for Caesarean Delivery

The post 092 – Accidental dural puncture and intrathecal catheters appeared first on obsgynaecritcare.

In Part 2 of epidural analgesia in labour we discuss common problems, difficulties and how to troubleshoot issues in our epidurals on labour ward.

Thanks again Matt & Shilpa!

The “Basics of Obstetric Anaesthesia” is a short series of podcasts, where we aim to discuss in a conversational manner the basic topics you will need to understand if you wish to practice obstetric anaesthesia. These will be especially useful to anaesthesia trainees new to obstetric anaesthesia but also may appeal to experienced practitioners wanting a refresher of the basics in this subspecialty area.

1 – Epidural analgesia in labour part 1

2 – Epidural analgesia in labour part 2, pitfalls and troubleshooting

3 – Accidental dural puncture and intrathecal catheters

4 – Post-dural puncture headaches and management

5 – Pre-eclampsia, eclampsia and hypertensive disorders

6 – General anaesthesia for Caesarean Delivery part 1

7 – General anaesthesia for Caesarean Delivery part 2

8 – Obstetric Haemorrhage

9 – Neuraxial anaesthesia for Caesarean Delivery

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