pain med...

hello, stephera,

i moved your thread to the ob/midwifery forum for a better response.

we very commonly use nubain 10mg with phenergan 12.5-25mg IVP. We hardly ever use Demerol. But that's just where I work; I'm sure it's different elsewhere.

fentanyl is nice, and it doesnt slow labor like an epidural...

We usually use Stadol/Phenergan. Occasionally Demerol/Phenergan, but Demerol has to be ordered after first jumping through flaming hoops and making sacrifices to the right gods, so mostly the residents will just order Stadol.

We have not used Demerol in YEARS on our unit, for any patient, whether in labor/delivery or post-op.

We use:

Stadol, 1-2 mg IVP every 2 hours.

Or

Nubain, 5-20 mg IVP every 2-4 hours.

For Therapeutic rest in prodromal or very early labor, we often give 10 mg Morphine, with 12.5-25 mg Phenergan IM. This often works great to get mom comfy enough to either rest til she goes into active labor, or conks out prodromal discomfort for hours. I am glad our docs allow this-----I hate to see them so uncomfortable and do nothing for them.

We are also allowed to give Phenergan, IM only, for nausea and in some cases, pain control, but never IV due to its potential vessicant problems. I do NOT like giving Phenergan in labor patients at all. Makes them way too sleepy and dopey, more so than Stadol or Nubain, in my experience. If patients are nauseated, we are allowed to give Anzemet, 12.5 mg IVP and it works!

Regarding Fentanyl: I used to use Fentanyl, IVP, 25-100mcg every 2-4 hours where I used to work in Oklahoma. Used to also have to have patient on pulse ox monitor when Fentanyl was in use, as I recall......

I have never seen Demerol used in labor in 8 years' L/D nursing, however, I do remember them giving a shot of it in my rear when I was in labor w/my son 13 years ago. It was totally useless. I wound up begging for an epidural at 8cm.

From what I have learned, Demerol is no longer recommended in L/D (and many other units) due to its capability to lower the seizure threshold in some people. Like I said, I have not even seen that drug stocked where I work in years.

Doesn't Demerol also make babies a lot sleepier/drugged when they are born than Stadol/Nubain? I'm pretty sure I've read that that is also a big reason it isn't used in L&D anymore.

Fentanyl; Fentanyl and Phenergan; Fentanyl and Benadryl,,,called a Fenadryl cocktail, LOL, Demerol rarely. Morphine for early/prodromal labor. Usually don't want to use Demerol too close to delivery cause it can make baby sleepy.

all narcotics can make a baby sleepy too close to delivery, be aware.

We had one the other night who would not breathe after a nurse gave just 5 mg nubain about 70 min prior to delivery. Had to have Narcan and was in our SCN for 6 hours' observation afterward, having to be stimulated to breathe and NOT desat below 95%...... Be really aware all narcs can do this, nubain, (actually an antagonist), demerol, fentanyl, and stadol can ALL do this.

We use stadol. I've only had to give Narcan once because of mulitple doses. I generally tend not to give it after 8 cm unless the doc okays it. I have seen Morphine given a few times. Some of our docs use a Demerol/Phenegran cocktail for a long prodromal labor just to give the mom a rest and hopefully help her rest some.
Mostly we use Epidurals though. I think our epidural rate is above 85%.
Happy New year!