pain med...

We have one doc that orders Fentanyl 100mcg q 30 minutes. All the other docs order it q 1 hour. Q 1 hour is not often enough in my opinion, the mom's are always in as much pain as they started shortly after the 30 minute period. I had a mom yesterday begging me to give her more after 20 minutes. I've never had a problem with respiratory depression in the baby or the mother.

Ah, nisentil. what a great drug! taken off the market after a couple of older pts died after surgery. We would give it at 3 or 4 cm's and moms would sleep til almost complete. It was before epidurals were common place in the late 70's and ealy 80's. I miss it.

We use fentanyl only. I have heard of stadol being used at my hospital and rarely nubain but for the most part fentanyl 50-100 mcg every 30 minutes.

Re Fentanyl. We use it for IV conscious sedation when patients are undergoing D&Cs. Our policy requires that the patient be on continuous ECG monitoring. We start our dose with 50 mcg. Are we being excessively cautious, or is your doctor a wild and crazy guy?

For labor when we expect a live birth we use Stadol. For labor induction for losses we use Demerol and Phenergan IV push (the nurses dilute the phenergan in saline).

Fentanyl IV push, 100 mcg. q 1 hour up to a max. of 6 doses in 24 hours. We push is very slowly, like over 3-5 min. Some RN push it over 3 contractions but I think that could take too long. I agree that it doesn't work all that well if they are really active. I have noticed it causes alot of patients to vomit (oh, joy!!)....but it works well if they are in early active phase.

When I'm in the nursery, I'd much rather get a baby of a mom who got Fentanyl than Nubain. And I've never ever seen Demerol used, EVER.

I push the fentanyl into the IV line with the IVF at the usual drip rate. It goes in slowly enough, IMHO. If the pt has a saline lock, I mix it with sterile NS and slow push then flush. The usual order is 50 -- 100 mcgs IVP Q 1 hour x 3 maximum. Moms usually start asking for it around 2 -- 4 cm; I know they'll eventually want an epidural when they ask this early, especially the nullips. If in transition fentanyl doesn't do squat.

I worked one hospital as a traveler where they regularly used fentanyl PCAs, with 500 mcgs of fentanyl in the pump. 25 mcgs per dose, 8 min lockout, I think, forget the maximum lockout. I'm not kidding. My eyes popped out when I saw that. Many of their pts were tiny Oaxacan women who would push, push, push those PCA buttons. I remember one nurse's pt OD'd on the stuff; her respirations dropped very low, she was unresponsive, and they gave her narcan. I had another tiny Oaxacan woman use up the ENTIRE CASSETTE. She was drugged out but the staff didn't think anything of it. She used it up before her labor was over with, then as it wore off it was like she woke up. Miraculously the baby wasn't affected -- I think it had worn off by then.

Wow what an interesting thread. I've seen iv fentanyl used i labour once in 16 years. We use pethidine as opposed to morphia and I haven't even heard of some of the narcotics you guys refer to. Our units epidural rate is 20% and we use lots of nitrous oxide (gas & air as they call it in the UK). We don't push epidurals unless women are desperate to have one from the start, which are few. We usually start with the nitrous and work our way up the ladder so to speak. Unless of course a woman is not at all coping and then on the odd occasion an epidural may be suggested before anything else. We also use our showers to death, usually with the nitrous, we have extra long tubing that extends into the shower. Most of our women without any risk factors needing CEFM, would spend some of the time in the shower. Some are there the whole time and even birth there.

We use mostly Nubain, some Stadol. Fairly low epidural rate~probably around 30-40%.
Rarely have any problems with neonatal depression with Nubain, and if there is any, Narcan to the baby fixes it. (Nubain isn't normally given after 7-8 cm).

Thanks for this thread!