Fentanyl for Labor Pain?

  1. Hello Everyone,

    We don't routinely give IV Fentanyl here for labor pain. A physician recently wanted one of our staff members to give this to her patient. The staff is not comfortable giving this to labor patients. Does your facility use Fentanyl IV for labor pain? If so, is there a protocol that involves placing the patient on a cardiac and SaO2 monitor? I would appreciate any input.

    Thank-you!
    •  
  2. 24 Comments

  3. by   mother/babyRN
    We don't give fentanyl iv ( and wouldn't) We do give nubain and I routinely gave stadol at another facility. Both facilities use fentanyl and bipivicaine as epidural ingredients...
  4. by   rdhdnrs
    We give Fentanyl all the time for labor pain. We usually give 100mcg/hr prn for early labor pain. We don't have any special monitoring; it is a narcotic and we use all the usual precautions that we do with any narcotic. We have had good luck with it.
  5. by   SmilingBluEyes
    It is among the several choices for labor pain among nubain and stadol. WE give anywhere from 25-100 mcg q 1 h for labor pain, via slow IV. Like with any narcotic, as redhead said above, you need to watch its effects on mom and baby and understand the more it is used, the less the effects are felt.
  6. by   fergus51
    We give it to women who we consider too far along to be able to take meperedine. Only women less than 3 cm are allowed meperedine, but they can have fentnyl up to 7 cm because it's effects wear off faster. We don't place them on cardiac or oxygen sat monitoring.
  7. by   SmilingBluEyes
    We pretty much stopped using demerol in any form on our floors (even in PCA), quite some time ago. It is implicated causing seizure activity in some people, I have read in several journals. And they are finding fentanyl and morphine much more effective, especially in post-surgical pain control, with fewer side effects .Go figure?
  8. by   Jolie
    Dear layna and mother/babyRN,

    I'm curious as to why you have such strong feelings against using Fentanyl for labor pain relief. I have never used it for labor patients, but received it for post-op pain on 2 occasions when Demerol just wasn't doing the job, and got great relief. I remember being in labor with my first baby, with no anesthesiologist available for an epidural. I was given Demerol and might as well have received a placebo for all the good it did.
    With my second labor, I was given Stadol for early labor pain and it knocked me out so that I slept for hours and slowed my progress. I can't help but wonder if Fentanyl would have been a better choice for me. (Not that I'm willing to try it again to find out!)

    Just curious.
  9. by   NurseyNursey
    I gave Fentanyl quite a bit at the first facility where I did L&D. I also got some when I was in labor with my first, but it only helped through about 2 contractions. I went from 0/100% to delivered baby in about 2 1/2 hours. I don't think much would have helped. Now, if I could have gotten that intrathecal that I wanted that the anes. resident wouldn't give me since I was a primip...
  10. by   HazeK
    Fentanyl is supposedly bound up more in the placental villi,
    resulting in less getting to the fetus....

    sorry, no documentation other than the word of a reputable OB and a reputable anesthesiologist!

    anyone else ever heard of this???

    hhk
  11. by   OBNurseShelley
    I have heard that too as well, one facility I worked at, fentanyl was used exclusively, 100mcg every hour up to 3 doses, no matter how far they were dilated. another facility ONLY uses demerol/phenergan which I think is useless 90% of the time, and another used stadol or nubaine, i've had good luck with nubaine. Interesting how different places can be!
  12. by   layna
    The reason for my post is that a staff member was asked to give it to a patient that was not receiving relief from Stadol. The nurse was not comfortable with it. To make matters more confusing, a nurse certified in conscious sedation believed that Fentanyl should be given only if there is a policy in place and the patient is placed on a cardiopulmonary monitor. I believe that there is a big difference between a patient being prepped for conscious sedation verses a labor patient requesting analgesia. Since we don't give Fentanyl here, I wanted to know what the rest of you out there are doing in regards to Fentanyl for labor pain. I really appreciate all of this input!
  13. by   Spidey's mom
    Yep, we give it here occasionally . . .I did it a week ago. No special monitoring except a doc needs to be in the room (or pretty handy :-)

    We do not give Demerol much anymore on any of our patients . . . new info a couple of years ago regarding how little Demerol really works for pain control and the seizure risk . . and we are phasing it out.

    steph
  14. by   RMH
    Our policy is that the MD should be in the room. We give it frequently to patients waiting to get an epidural, with good results..The MD's are wanting to use it more and more because of the short duration, so we are in the process of getting policy changed so Rn's can give it in labor without the MD being present. Of coarse with O2 monitoring.
    RMH

close