IV meds for Labor, what do you use?

  1. Just curious to see what everyone else uses. We used to have demerol but we can't get it anymore, now we have stadol and nubaine(nalbuphine) I've heard of some places using fentanyl, and I have used that a few times.........WHat's your opinion and what do you like best?
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  2. 24 Comments

  3. by   mark_LD_RN
    we use demerol some with the older docs, newer ones like stadol 1mg q1 hour. the midwives like nubain. I love that stuff if my patient wants pain meds that i request the doc give them nubain.

    I am not sure what the deal is with nubain but we often give it to a pt at 3-4 cm, she rests a few hours and wakes up complete
  4. by   OBNurseShelley
    we give 10mg and ive seen it work and ive seen it do NOTHING, we repeat it as often as x2 one hour apart...
  5. by   mark_LD_RN
    we give 10 nubain with 12.5 phenergan, works great most of the time, but occasionally it does not work well
  6. by   bagladyrn
    Mostly have been using stadol or nubain, occasionally a doc orders demerol (varies from place to place) Nubain does seem to work well for many women. My favorite reaction was a pt. getting nubain for the first time - when the effects hit her, she got a big smile on her face and said to me "Wow - do they sell this stuff on the street?" Her mother was sitting at the bedside and was aghast!
  7. by   Jolie
    Can't get Demerol anymore? How come? I had Stadol for pain relief in early labor and was so zoned out from it that I wouldn't want to try it again. Good thing I didn't deliver for several hours and it had a chance to wear off.

    Our well-baby nursery nurses used to complain about the effects of Nubain on the infant's respiratory status, even if given 4 or more hours before delivery. I personally can't say that I noticed any problems in our NICU babies, but many of them required ventilation anyway. Is anyone aware of any increased respiratory depression with Nubain as opposed to other drugs?
  8. by   SmilingBluEyes
    Stadol 1-2 mg q 2 h...or Nubain 5-10 mg q1-2 h.......NEVER demerol......rarely use IV drugs; epidural or natural are the methods of choice, primarily. At my last hospital we used Fentanyl 25-100mcg q2 h......Have not seen that done up here, tho.
  9. by   finallyRN
    We use Fentanyl 50-100mcg alot here. We also use 1-2 mg of Stadol. Nubain is only used by a few of our docs. I find that Nubain tends to work the best though. I wish more of our docs would use it.
  10. by   anitame
    We almost always use Fentanyl as a first choice drug for pain meds, it's a standing order on our labor order sheet. Even if they have planned an epidural, they often get the Fentanyl while waiting. We have around a 30% epidural rate, the rest mostly use Fentanyl with the occasional nonmedicated labor. We use 50mcg over 2 contractions. May be repeated in 10 minutes, not to exceed 100mcg q 1 hour. We will sometimes give the 50, wait the 10 min, then give the other 50; sometimes we give 50 q 30 min. Depends on the patient, the labor, etc. I have started using the 100mcg dose more often, it tends to give a little better relief.
    There are several things about Fentanyl that are great. One is that is has a very short half-life and we see VERY few sedated babies. The other thing is that there is no limit to the dosing. I've heard with either Nubain or Stadol (can't remember which) you can only give a couple doses.
  11. by   OBNurseShelley
    I'm interested in learning more about the use of fentanyl, where do you work? Do you know of any contraindications or certain side effects? Do you know of any research articles related to the use and effectiveness....you're right about stadol and nubaine, you cant give either close to delivery because it sedates the babies.....our docs won't use it......they get nervous about having to give it so often........but a nurse that I used to work with went to california to work and that was all they used at her new facility and it was also a standing order........at what point do yo usually give it to them and at what point do you think it's most effective....do you give 100mcg at a time? or usually the 50 then a couple minutes later the other 50? SOrry for so many questions just trying to learn more! Feel free to email me. Shelleyrn_66213@hotmail.com thanks Shelley!
  12. by   mark_LD_RN
    anitame

    it is stadol after 3rd dose it is like giving water to most of our patients. it seems to lose it effect with each dose.
  13. by   SmilingBluEyes
    Mark, I find that is true w/most narcotics. If given too long,they lose their effect and no longer provide pain relief. Most of the ladies I care for who ask early on for IV meds are the ones who will have epidural anesthesia sooner or later (and NO I never, ever push it anyone, it is 100% up to them.). I only find IV drugs help some of them thru who are good at breathing w/labor and can stay on top of the pain most of the time, anyhow. Just what I have observed, not saying it's right or wrong.
  14. by   L&D.RN
    We use Stadol a lot, but I find that for most people it doesn't really help with the pain at all, but it takes the edge off and helps them relax so they can stay in control of and on top of the pain of the contractions. One patient described it perfectly, "It didn't help with the pain at all, but it made it so I didn't give a **** that I was having it!" Some of the docs will even let pts have Stadol when they're complete and have a little pushing to do. The babies haven't been affected, but it worried us.

    In CA, we gave Fentanyl, seemed to work way better, but no docs to it here in WA. We still give Demerol or Morphine (w/visteril or phenergen) if they are in early labor, gets them rest and relaxation through the night and they wake up more dilated.

    I was impressed with someone's 35% epidural rate. Ours is much higher. Pts come in with their minds made up that is what they want, and the first contraction that is painful they start asking for it. Its pretty hard to do anything else without them having an open mind.

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