GTN (nitric oxide donor)
2 sprays of sublingual GTN
Use a 1ml syringe and give bolus of 0.2-0.3mls from 5mg/5ml GTN ampoule
Repeat bolus at 5-minute intervals
Large-bore IV line + volume support
Monitor BP, ECG, and respiratory rate
Contraindications to GTN
2. Raised intracranial pressure
3. Sensitivity to nitrates
Disposable Vygon PCA sets
Available in the ODA's room.
They have to be freshly made up by the anaesthetists. Morphine can be used 2mg/ml; 0.5 ml bolus; lockout 5 minutes. Alternatively, use fentanyl: To make up; take 2 large ampoules of fentanyl (1000mcg in 20mls), add 5mls of N Saline, and put in Vygon PCA. This will give 50 boluses of 20mcg (40mcg/ml; 0.5ml bolus)
Currently PCA’s are not allowed on the post (or ante) natal wards due to staff training issues.
If you feel that oral analgesics will provide inadequate pain relief in a particular case then the mother may be kept on delivery suite; either continue to use the epidural if present or set up a PCA.