The QCCH GTN and Vygon PCA

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

1. Hypovolaemia

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.