| Types | Characteristics | Nursing Implications |
|---|---|---|
| Common Agents in 0.5%–1.0% Solution | ||
| Lidocaine (Xylocaine) Bupivacaine HCl (Marcaine) Tetracaine HCl (Pontocaine) Mepivacaine HCl (Carbocaine) Chloroprocaine HCl (Nesacaine) Ropivacaine (Norapin) | Used with epinephrine (or other vasoconstrictor drug) to delay absorption, prolong anesthetic effect, and decrease chance of hypotension | Note any history of allergy; note response: allergic reaction, hypotension, and lack of wearing off of anesthetic effect; observe for hypertensive crisis if agent combined with epinephrine and oxytocin is also being given |
| Peripheral Nerve Block | ||
| Pudendal (5–10 mL each side) anesthetizes lower two thirds of vagina and perineum | Perineal anesthesia of short duration (30 min); local anesthesia; simple and safe; does not depress neonate; may inhibit bearing-down reflex | To get cooperation, give explanation during procedure |
| Paracervical (uterosacral) block (5–10 mL given into each side) anesthetizes cervix and upper two thirds of vagina; note: used more for gynecological surgery than for labor | When the cervix is dilated, may be given between 3 and 8 cm by physician when woman is having at least 3 contractions in 10 min; lasts 45–90 min; can be repeated; can be followed by local, epidural, or other; may cause temporary fetal bradycardia | Explain: especially length and type of needle; take maternal vital signs and fetal heart rate (FHR); have her void; help position; monitor FHR continuously; monitor contractions; and watch for return of pain |
| Local infiltration | Useful for perineal repairs | No special nursing care |
| Epidural lumbar block | Useful during first and second stages; can be given “one shot” or continuously; T10 to S5 for vaginal birth; T8 to S1 for abdominal birth; complete anesthesia for labor and birth |  Hypotension (with resultant fetal bradycardia): (a) turn from supine to lateral, or elevate legs, (b) administer humidified oxygen by mask at 8–10 L/min, (c) increase rate of IV fluids (use infusate without oxytocin); will need coaching to push, and low forceps or vacuum may be required |
| Peripheral Nerve Block | ||
| Subarachnoid spinal | ||
| Useful during first or second stage of labor, or for abdominal surgery | Instruct when to bear down |
| Same as continuous | Same as continuous |
| Intrathecal (spinal): morphine, fentanyl, sufentanil | 0.5 mg produces marked analgesia for 12–24 hr; onset in 20–30 min Fentanyl and sufentanil produce short-acting analgesia (1½–3½ hr) | Side effects: respiratory depression, pruritus, nausea, vomiting, sleepiness, urinary retention; keep naloxone 0.4 mg at bed-side and respiratory support equipment readily available |