Women’s Anaesthesia

Delivery Suite Pain Relief Services

The Department of Women’s Anaesthesia was first set up in 1975 to provide anaesthetic (temporary pain relief) and analgesia (types of pain reliever) for women. As the leading hospital for women’s healthcare, we constantly strive to achieve a higher standard of care amongst our delivering mothers.

In 1985, we offered our parents the assurance that an anaesthetic specialist is available 24-hour a day to provide consultation and pain relief care to mothers in labour and ensure they enjoy a safe and comfortable labour and delivery.

1. We provide a full range of comprehensive pain management services which includes
2. Inhalational Entonox (type of analgesia consisting of nitrous oxide and oxygen)
3. Intramuscular Pethidine (fast-acting opioid analgesic injection)
4. Patient Controlled Intravenous Remifentanil (potent short acting synthetic opioid analgesic)
5. Epidural/ Combined Spinal Epidural (CSE)
6. Patient Controlled Epidural Analgesia (PCEA)
7. Computer-Integrated Patient Controlled Epidural Analgesia (CI-PCEA)
8. Epidural Pain Relief

Each year, approximately 40% of our patients in labour opt for epidural pain relief during labour. Annually, more than 5,000 mothers benefit from our epidural and combined spinal and epidural techniques for labour and delivery. We have safely provided epidural pain relief for more than 100,000 patients since the inception of our epidural service.

Our incidence of epidural related complications is one of the lowest and comparable with many major tertiary centres. A recent audit of our centres epidural related side effects and complications shows:

ALOS (in days) for pneumonia for each month in 2008

• Hypotension 0.8%
• Fetal bradycardia (decrease in fetal heart rate) 0.5%
• Dural puncture 0.2%
• LA Toxicity 0%
• High Block 0.1%
• Repeat procedure 0.9%

Combined Spinal Epidural

In 1997, KKH was the first hospital in Singapore to adopt the Combined Spinal Epidural (CSE) technique for labour pain relief, This technique has since shown to be safe and superior in providing a faster onset of pain relief with increased patient satisfaction.

In a recent audit of more than 1,000 mothers who received the CSE technique, we found a lower incidence of side effects and higher patient satisfactions.

• Motor block 1%
• Postpartum backache 10%
• Postpartum headache 2.5%
• Postpartum neural deficit 0%
• Postpartum urinary retention 5%

Patient Controlled Epidural Analgesia

In 1999, the department of Women’s Anaesthesia was the first in Singapore to initiate the Patient Controlled Epidural Analgesia (PCEA) programme and made patient controlled analgesia available amongst our women in labour. This programme has shown to improve patient satisfaction and reduce the amount of pain relief medication required during labour. Our continuous strive for excellence in the field of pain relief for labouring mothers has resulted in the innovative development of the computer-integrated PCEA service with a central monitoring system. This will be launched in 2009 in our 32-bedded delivery suite and will further enhance our pain relief service.

An audit of our patient’s satisfaction with their pain relief during labour is conducted on an annual basis. From 2006 to 2007, we actively sought to improve patient’s satisfaction by obtaining feedback from postpartum patients. Patients whose satisfaction scores was <75% were interviewed by the anaesthetic pain management team, and reviewed personally by the attending consultant anaesthetist if they have further queries. This resulted in a steady improvement of patient’s satisfaction over the years.

Research, Teaching and Training

Our staff members are also dedicated to research, teaching & training. Our anaesthetists hold faculty appointments at the National University of Singapore, Yong Loo Lin School of Medicine and Duke-NUS Graduate Medical School. Our continuous series of clinical and translation research works aim to improve patient care and increase safety in labour pain relief. Our department frequently collaborates with anaesthetic faculties from United Kingdom, Australia and Indonesia, organising obstetric workshops and providing training for both local and overseas medical personnel in the management of high-risk mothers.

“The delivery of the infant into the arms of a conscious and pain-free mother is one of the most exciting and rewarding moments in medicine” Moir DD, 1979.