What do you use for Post Delivery pain meds?

  1. What would your typical order be for both a regular vaginal delivery (say, with or without an epidural), and for after a C-Section.

    Are narcotics usually used? Do they have any affect on breast feeding?

    Thanks,

    NurseFirst
    •  
  2. 21 Comments

  3. by   babyktchr
    We use motrin 800mg for SVD with a T3 back up if needed. For sections..they usually come back with PCA and toradol...then percocet and motrin.
  4. by   USA987
    For vag deliveries we use Motrin 600 mg q4-6hrs and Vicodin 1-2 tabs q3-4hrs (8 tabs max/24hrs). Most stick with Motrin, but those with 3 & 4 degree lacs tend to take a few Vicodin a day as well.

    For c/sections...they receive Duramorph in the OR. For breakthough pain in the first 12-24 hrs they usually receive Toradol IV and Tylox PO. After 24 hrs they revert to the standard post-delivery orders as listed above for vag deliveries. For my sections I really like to get into a pattern of alternating between Motrin & Vicodin (1) every 3 hrs. to keep ahead of their pain. The less discomfort they feel, the better they'll move. And of course, the quicker they'll recover
  5. by   parteiranagua
    Quote from NurseFirst
    What would your typical order be for both a regular vaginal delivery (say, with or without an epidural), and for after a C-Section.

    Are narcotics usually used? Do they have any affect on breast feeding?

    Thanks,

    NurseFirst
    I have seen the difference between BB who are affected by meds and the ones whose mothers dont take any narcs...

    for furhter info pls read by Mary Krueger CNM: Impact of birthing practices on Breastfeeding..

    Ginny DOULA RN SNM
  6. by   babyktchr
    Quote from USA987
    For vag deliveries we use Motrin 600 mg q4-6hrs and Vicodin 1-2 tabs q3-4hrs (8 tabs max/24hrs). Most stick with Motrin, but those with 3 & 4 degree lacs tend to take a few Vicodin a day as well.

    For c/sections...they receive Duramorph in the OR. For breakthough pain in the first 12-24 hrs they usually receive Toradol IV and Tylox PO. After 24 hrs they revert to the standard post-delivery orders as listed above for vag deliveries. For my sections I really like to get into a pattern of alternating between Motrin & Vicodin (1) every 3 hrs. to keep ahead of their pain. The less discomfort they feel, the better they'll move. And of course, the quicker they'll recover

    Duramorph...wow....lucky you!!! We stopped using it eons ago. How do you think they fair with it?? As I remember, they itch themselves to death, but they moved well and really had no pain. We used Toradol for breakthrough in that case. I wish we would use it again....heavy sigh
  7. by   LauraLou
    We mostly use Motrin and Lortab for a vag and Motrin and Percocet/Percodan for a c/s.
  8. by   BETSRN
    Quote from NurseFirst
    What would your typical order be for both a regular vaginal delivery (say, with or without an epidural), and for after a C-Section.

    Are narcotics usually used? Do they have any affect on breast feeding?

    Thanks,

    NurseFirst
    We use Motrin 600-800 and/or Percocets. Our c/s usually have Duramorph (not always and sometimes a PCA) and then go right to the PO meds I mentioned the next day.
    These meds are NOT a problem with breastfeeding.
  9. by   USA987
    Quote from babyktchr
    Duramorph...wow....lucky you!!! We stopped using it eons ago. How do you think they fair with it?? As I remember, they itch themselves to death, but they moved well and really had no pain. We used Toradol for breakthrough in that case. I wish we would use it again....heavy sigh
    The biggest side effect does seem to be the itching. 90% of them do very well with only the Duramorph on board. I tend to premedicate them prior to getting them out of bed for the first time just to really get them ready to get moving.

    Why did your facility quit using it???
  10. by   palesarah
    Standard post-partum vag delivery orders are for 600mg Mtorin q4-6 and Percoset 1 or 2 tabs q 3, most just stick with the motrin but the percoset is pretty popular at night, especially with multips who may be experiencing stonger cramps
    Post-C/S, usual orders are toradol IV Q6 for the first day with morphine IV for breakthrough pain- most of our sections also get duramorph spinals in the OR, one practice also uses a "pain ball" thing that delivers marcaine to the incision site. On the second day post section pts also go to motrin/percoset.
    Haven't noticed any difference in breastfeeding babies of moms who take narcs postpartum vs moms who don't.
  11. by   babyktchr
    Quote from USA987
    The biggest side effect does seem to be the itching. 90% of them do very well with only the Duramorph on board. I tend to premedicate them prior to getting them out of bed for the first time just to really get them ready to get moving.

    Why did your facility quit using it???
    I have no clue why they stopped using it. The anesthesia gods must have gotten together one day and said...no more. Every once in a doctors wife or nurse will request it...but otherwise we just don't see it. We have a new anesthesia doc who uses intrathecal injection of something that kinda mimics the duramorph effect. It doesn't work. I remember this facility using it more in CCU than anywhere else.
  12. by   BETSRN
    Quote from babyktchr
    Duramorph...wow....lucky you!!! We stopped using it eons ago. How do you think they fair with it?? As I remember, they itch themselves to death, but they moved well and really had no pain. We used Toradol for breakthrough in that case. I wish we would use it again....heavy sigh
    Why did you guys quit using Duramorph? That's the modern way!! LOL
  13. by   SmilingBluEyes
    Some anesthesiologists (and modern ones too) do NOT use duramorph due to its potential sedating and VERY strong tendencies to interfere with bladder and bowel innervation. I work with a new anesthesiologist (who is brand new this year) who REFUSES to use duramorph due to current studies/evidence and personal experience in residency of the above problems. It just depends on individual practice.

    Anecdotally, I had a duramorph spinal myself for my csection and it did not do a damn thing to control post-op pain for me. It's not always what it's cracked up to be....at least from my experience. Like anything else, it either works, or it does not. And the potential for respiratory problems is such we have to monitor them on Sat Monitors for 24 hours post-op, as well as leave catheters in that long. THAT should tell us something......that is, at least, it's not without LOTS of risks neuro and respiratory-wise, despite the benefits.

    And the ITCHING is also a a HUGE inconvenience and problem........necessitating sedating treatments such as Benedryl or Nubain.
    Last edit by SmilingBluEyes on Mar 21, '05
  14. by   Jolie
    Quote from BETSRN
    Why did you guys quit using Duramorph? That's the modern way!! LOL

    It amazes me that ANYONE in 21st century OB would still be using Duramorph.

    Back in the early 90's our anesthesiologists switched to continuous epidural PCAs for C-section patients with a huge dropoff in complications and a much greater level of statisfaction on the part of patients, nurses, and OBs/CNMs.

    Moms get consistently good levels of pain relief, are up and walking by the evening of surgery, have no complaints of itching, and virtually no problems with voiding once their Foleys are removed. They switch easily to po pain meds after 24 hours or so, and I don't ever remember having to give anything IM for breakthrough pain.

    If anyone insisted on giving me Duramorph for a C-section, I'd get up and go to another hospital!

close