Pharmacological methods
A range of analgesic and anaesthetic options are available in pregnancy. These include non-opioid drugs, opioid drugs, and regional analgesia/anaesthetic techniques.
Non-opioid drugs
Paracetamol
Uses: antenatal period, intra-partum period, and postpartum period.
Mechanism of action: the analgesic actions of paracetamol are poorly understood. It has been shown to inhibit the cyclooxygenase (COX)-3 enzyme in animal studies, but this COX variant has subsequently been shown not to be active in humans. Current theories suggest its analgesic action may be due to the activity of its metabolites. It does, however, exhibit some inhibition of COX enzymes in humans, thereby reducing central prostaglandin production resulting in its antipyretic and limited antiinflammatory effects.
Dose: 4 g daily in divided doses (or 15 mg/kg if weight is interventions in theatre. The clinical situation and the urgency of the situation often dictate which method of regional analgesia or anaesthesia is used. Effective epidural/spinal block can allow caesarean section, or the trial of operative vaginal birth in theatre with immediate conversion to a caesarean section if necessary (6).