Looking for info on intrathecals & labor...

  1. Hello!
    I am an RN in a rural community hospital that does about 350-400 deliveries per year. We do not have epidurals available, however we do offer intrathecals (one time injection of narcotic into the intrathecal space) for pain control option for laboring moms. We are looking for info from other places that use intrathecals on:
    1 - What drugs do you use? (We use duramorph & fentanyl, but seem to have a lot of side effects like urinary retention, pruritis, & nausea - looking to see what other places use/ what your experience are)
    2- Do you require any immediate labwork/ any labwork prior to the procedure? (One of CRNAs requires stat PT/PTT/INRs on his pts prior to doing the procedure - which can delay the procedure 30 or more minutes...)
    3- What type/ frequency of side effects do you see & what do you do to treat the side effects?

    Any info you can offer would be GREATLY appreciated!!
    Thanks again -
    JMC
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  2. 10 Comments

  3. by   illeniccup
    jmcrn: I am not an OB RN, but plan to be one some day. I HAVE, however, had an intrathecal for labor pain management. My anesthesiologist used morphine...the pain relief was TERRIFIC, but the side effects for me were bad...the shakes, itching, vomiting...uuuuhh! My postpartum nurses told me to expect it to last up to 18 hours, which it did. I was SO shaky and "out of it"--mind you, I'd had no other meds for pain--that I could not even hold my daughter until the next morning. PLUS, I had to have a catheter because I couldn't get off my duff to go to the bathroom--thought I would pass out! They had given me IV Benadryl in recovery to "help take the edge off" the shakes, but this raised my heartrate to 135 bpm, causing a whole other ruckus! I felt like I was the WORST patient they could have had! ANYWAY, I know this is not from a professional standpoint, but it's from a pt's view...hope it helps in some way!
  4. by   mother/babyRN
    We haven't had that sort of side effect that I am aware of. What else did they use? I am just curious.
  5. by   labornurse
    Anestheisa at our hospital uses fentanyl. None of the side effects mentioned about have happened in my experience after an intrathecal. All of the pts I have had, that have had intrathecals, have been very satisfied with the results.
  6. by   indynurse
    1) We use mostly duramorph and fentanyl. I think one of the anesthesiologists uses bupivicaine sometimes.

    2) All of our labor patients have CBC's drawn on admit and anesthesia will look at the platelets first. Unless the patient has something in their history or assessment that raises a flag, that is the only blood test considered before giving intrathecal narcotics.

    3) We only use the intrathecals for c-sections so most of our patients will have a foley catheter until the following morning, but even then, we still see urinary retention linger in a few women. Nausea and vomiting are fairly common. I try not to give my pts anything to eat or drink for at least the first couple of hours. I warn them all about the itching and the N/V and encourage them to ask for meds when they first start feeling these effects. As far as itching goes, most of our pts will get some relief from either Benadryl or Revex. I have also seen Nubain ordered for it. For intractable itching, we usually start a Narcan drip that usually knocks it out, but it also reverses the analgesic effects.
  7. by   louloubell1
    Nubain will reverse the analgesic effects as well. We use nubain as a last resort like narcan for that reason. We usually try benadryl or vistaril first.
  8. by   SmilingBluEyes
    Originally posted by jmcrn
    Hello!
    2- Do you require any immediate labwork/ any labwork prior to the procedure? (One of CRNAs requires stat PT/PTT/INRs on his pts prior to doing the procedure - which can delay the procedure 30 or more minutes...)
    JMC
    ALL the above labs are required by our anesthesia crew. So, we get these labs on ALL patients admitted for labor since even if they plan to go w/o anesthesia, we are ready in case of emergent csection or a change of heart. This reduces any delay in getting the spinal, epidural or intrathecal anesthesia our patients request or require.
  9. by   heanh
    I work in a rural hospital in minnesota-we have about 300+ deliveries/year. we only use intrathecals. sufenta is the drug of choice. used to use morphine but switched d/t severe vomiting.
  10. by   SmilingBluEyes
    Welcome to the boards, Heanh!!!!!!!!!!!!!!!
  11. by   OBNurseShelley
    this might be a stupid question, but what exactly is an intrathecal? How is this different from a spinal/epdidural, and is this like a "walking epidural"? can patients walk? we use bupivicaine and fentanyl for epdiurals and duramorph for spinals.....ive only worked in larger facilities that have epidurals.....do the intrathecals last throughout labor or do they have to be redone? thanks for the info!
  12. by   SmilingBluEyes
    This explains it very well, at least the way I would....

    http://www.parentsplace.com/expert/m...100750,00.html

    Intrathecals are a one-shot quick deal and NOT meant for protracted/long labors. They last only a few hours and may need to be repeated if pain returns before labor comes to an end. It's up to anesthesia personnel and the obstetric care providers as to which form of anethesia is appropriate in each case.

    We rarely do intrathecals where I work, usually because women ask for anesthesia so early-on (2-3 cm often), so they would not last. Even later in labor, our MDA's choose to initiate epidural anesthesia over intrathecal type, perhaps due to the small chance a csection COULD be needed and the anesthesia route/med drip would still be in place if such need arose. HOPE THIS HELPS!!!

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