Using Narcan to help Pts to Void Post C/S

[Hyrita]

Here's the situation:

1. Post Op Repeat C/S

2. Duramorph Spinal

3. Foley has been removed, but pt unable to void after 8 hrs (hospital policy).

We'd tried everything, water running, hand in water, OJ w/sugar, you know the usual stuff.

The agency LVN working with me said that the last place she worked, there was an order to given Narcan IVP to help pt's void. She also was told to make sure the patient was sitting on the toilet because it works right away. Unfortunately, she wasn't sure of the dose.

The poor patient was just miserable and I was very reluctant to I & O cath her (she stated she did not want another cath). I happened to notice her scratching her arm and asked her if she was itching. She said yes. I checked anesthesia orders and there was an order for 0.1 mg Narcan IVP for itching. So, I gave her the Narcan. I wasn't 2 steps out of the BR and the patient yelled out "it worked!". I stepped back into the BR and she was voiding. In fact, after a couple of minutes, she complained because she couldn't stop.

Has anyone ever heard of this? Is there research on it somewhere?

Thanks for your help on this.

[wtbcrna, MSN, DNP, CRNA]

Here's the situation:

1. Post Op Repeat C/S

2. Duramorph Spinal

3. Foley has been removed, but pt unable to void after 8 hrs (hospital policy).

We'd tried everything, water running, hand in water, OJ w/sugar, you know the usual stuff.

The agency LVN working with me said that the last place she worked, there was an order to given Narcan IVP to help pt's void. She also was told to make sure the patient was sitting on the toilet because it works right away. Unfortunately, she wasn't sure of the dose.

The poor patient was just miserable and I was very reluctant to I & O cath her (she stated she did not want another cath). I happened to notice her scratching her arm and asked her if she was itching. She said yes. I checked anesthesia orders and there was an order for 0.1 mg Narcan IVP for itching. So, I gave her the Narcan. I wasn't 2 steps out of the BR and the patient yelled out "it worked!". I stepped back into the BR and she was voiding. In fact, after a couple of minutes, she complained because she couldn't stop.

Has anyone ever heard of this? Is there research on it somewhere?

Thanks for your help on this.

Urinary retention is a common side-effect of morphine just as pruritus is. Technically, if opioid agonist (morphine) caused the problem then an opioid antagonist (narcan) should be able to reverse it. Another choice could have been to use an mixed opioid agonist-antagonist (nubain, stadol etc.) to reverse the mu related side effects while still maintaining analgesia. The dosage from the 2 references I looked should be the same as what you would give for pruritus (0.1mg up to 0.8mg).

Orthop Nurs. 2008 Mar-Apr;27(2):111-5.

A study of naloxone effect on urinary retention in the patient receiving morphine patient-controlled analgesia.

Gallo S, DuRand J, Pshon N.

St Joseph's Hospital, Member of HealthEast Care System, St Paul, MN, USA.

Comment in:

Orthop Nurs. 2008 Mar-Apr;27(2):116-22; quiz 123-4.

PURPOSE: The purpose of the study was to compare urinary retention rates following orthopaedic surgery in patients who received low-dose intravenous naloxone while receiving morphine patient-controlled analgesia with patients who did not receive naloxone. DESIGN: Randomized controlled trial without blinding. SAMPLE: There were 97 participants consenting to the study, 45 were randomly assigned to a control group and 52 assigned to an experimental group. Forty-three patients in the control group and 47 in the experimental group (90 total) completed the study protocol. FINDINGS: Postoperative urinary residuals were lower, patients voided more frequently, and fewer catheterizations were needed when given low-dose naloxone while receiving morphine patient-controlled analgesia. At the same time, naloxone in small doses was found to have negligible effect on overall patient pain control.

PMID: 18385594 [PubMed - indexed for MEDLINE]

[bigbub3000]

Good to know this.

[nrsang97, BSN, RN]

Interesting.

[babyktchr, BSN, RN]

We cannot remove foley's for 24 hours after Duramorph spinal because of the potential for urinary retention. We have narcan and nubain orders for itching. I am going to discuss the use of narcan when we have issues with voiding after epidurals etc with the chief of anesthesia though. Could be an alternative to re-cathing.

[wtbcrna, MSN, DNP, CRNA]

We cannot remove foley's for 24 hours after Duramorph spinal because of the potential for urinary retention. We have narcan and nubain orders for itching. I am going to discuss the use of narcan when we have issues with voiding after epidurals etc with the chief of anesthesia though. Could be an alternative to re-cathing.

Narcan probably wouldn't help after 24hrs. The Duramorph should pretty much be completely gone at that point unless you hospital has starting using Depodur which has 48hr duration. I would use nubain over narcan to preserve analgesia.

[Elvish, BSN, DNP, RN, NP]

That is interesting, and it makes perfect sense.

[NurseNora, BSN, RN]

We don't have orders to use Narcan for inability to void, but our post Duramorph anesthesia orders do say to notify anesthesia if patient is unable to void (in the first 24hrs after Duramorph administration)

[RNmomof4]

We don't have any standing order for the use of narcan to assist a patient with voiding after the foley is out, but we do have standing post op c/s orders for narcan if pt has decreased output, seems to work well.