Pain medication in Postpartum

Specialties Ob/Gyn

Published

i have done some research on types of pain medication that work best for different types of pain, but i am unable to find anything extensive.

i am aware of cramping being treated best with ibuprofen/naproxen, but what about incision pain or perineum pain or hemorrhoid pain. how do you use norco differently than toradol, etc.?

websites or insight would be greatly appreciated.

Specializes in OBGYN, Neonatal.

Wow compared to some of the responses here our unit provides a lot more meds, sometimes I wonder if that is the problem with our patients not wanting to get up.

CS come over with epidural in place and keep it 1-2 days there have been rare ppl who had it on day 3. I encourage removal as soon as they can tolerate it b/c I really don't see how it helps them a lot, some ppl yes but most of them seem to be ready to be done with it sooner rather than later. CS also have toradol q 6 for about 2 days. They can have percocet in between for breakthrough pain. lady partsl deliveries can have motrin 800 or percocet or both. I try to start out slow, if my patient is complaining of cramping (lady partsl) I try a motrin and then if that doesn't help or if they ask for somethign stronger I will try one percocet (we are allowed to do 1 or 2 q 4 hours prn). But I strongly encourage ambulation, especially for cs patients, they really need to get that gas out.

Personal experience, having had a cs as well as a few other surgeries, pca pain management is not good for me, I do better with po meds. I think toradol is good iv though for many pains and I think if I have another child and its a cs delivery I will try to find an alternate route, or have the epi pulled asap. I just don't find the benefit in it and always did better with other methods of pain management. And walking as soon as I could was always helpful!

I am just shocked sometimes at how much time post partum patients spend in bed, I think it really helps to be moving and doing things even if its just within one's room.

Specializes in Community, OB, Nursery.

Our c/s patients get duramorph (most folks) or PCA morphine/fentanyl (rarely). All our sections gets Toradol q6h x 24hrs. Once the Duramorph/PCA is gone they get Percocet 1-2 q4h around the clock x 24 hrs. After that it's Motrin 600mg q6 prn and the same dose of Percocet q4 prn.

lady partsls get around the clock Motrin, as well as prn Percocet. If they have a tear/epis or complain of perineal pain, they get Dermoplast spray and witch hazel pads. Most folks do okay with just the Motrin and topicals.

Agree with Cherokee that those who get up and around do MUCH better than those who don't.

Specializes in L&D,Wound Care, SNC.

Most of our C/S pts get spinal with Duramorph. Toradol q6x24 then percocet and Vitamin M (800 mg Motrin, the military's wonder drug). Vag deliveries will get Vitamin M q8h prn and if 3rd or 4th degree lac some of the MDs will allow 1-2 tab percocet q4h prn x24 hrs. They also get Dibucaine for hemorrhoids and witch hazel and sitz baths for perineal pain. Our facility does not use Epifoam, which is too bad because I had a 2nd degree lac with my daughter and the Epifoam in conjunction with ice packs was a godsend!

Most of our c/s get Duramorph. Depending on doc c/s pts either get Toradol 30mg q 6 X4 doses or 800mg Motrin q 8 for 1st 24 hrs. Then they switch to 400mg Motrin q 4 PRN and/or Norco 5, or 10 q 4 PRN.

lady partsl pts get ice packs, Tucks, Dermaplast for the tearing and hemorrhoids. And for pain pain meds they can have Motrin 400mg q 4 PRN and/or Norco 5 or 10 q 4 PRN.

Occassionally we have a c/s with Diluadid or Morphine PCA, but it's rare. Usually it's a pt with some sort of chronic pain issue. And for patients who can't tolerate or think they are allergic to Norco (some swear the nausea it can cause is an allergy) we can give Darvocet i to ii tabs q 4 PRN (watching closely the amounts of acetominophen) and sometimes we have pts taking Percocet.

We also have standing orders for acetominophen 650mg for headache or fever >100.4 and if fever resolved after 2 doses requires call to OB.

I agree with the others that those that get up and OOB sooner do the best!

Generally, at my hospital, standing orders for lady partsl delivers include benzocaine spray (we provide ice packs as well) for peri pain, hemorroidal cream for hemorrhoids, 800 mg ibuprofen for cramping and pain r/t peri swelling, 1 percocet for PP cramping (especially for a 3rd, 4th, etc. baby). Most c/s orders include toradol for first 24 hours, a couple 2 mg morphine, once in awhile demerol. After that, 2 percocets and 800 mgibuprofen around the clock!

Specializes in many.

Spinal for surgery, arrive to the floor with Morphine PCA running. PCA usually ordered for 12-24 hours but I will pull it earlier if the pt can tolerate. Toradol first dose intraop then 3 more doses q 8 hours. Switch to Ibuprofen 8 hours after last toradol. Percocet 1 or 2 every 4 or 6 hours as needed.

I encourage my lady partsl patients to take ibuprofen and can add Percocet as above if needed.

Ice and Dermoplast for every lady partsl delivery.

EVERY one should be moving ASAP and lots!

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