What to give- Percocet or Norco's

Specialties Ob/Gyn

Published

I'm new to PP. I have a question about pain control. What do you give, and how do you choose which narcotic to give?

I've looked up in reference manuals different meds (Percocet, Norco, Vicodin, Rocicet, Naproxen, etc). But just can't find what I'm looking for.

I've been told with a c/s: 24 hours after a delivery, dc pca pump then start oral Percocets and Naproxen if pt is tolerating regular diet. The next day, transition to Norco's in place of Percocets. Another nurse told me to stick with one or the other. For a vag, start with Perc's then transition to Norco's. (or stick with one or the other). We usually send them home with Vicodin and Ibuprofen scripts.

We also use Toradol the first 24 hours after delivery for c/s. And you cannot give Naproxen within 6 hours of Toradol. I also believe you have to look at the pt's pain tolerance and previous history with narcotics.

Any suggestions?

Up Vote Up Vote ×

I work out patient surgery, not PP, but do assess a lot of pain, and give a lot of pain medications.

If the doctor orders several pain medications you can, should, ask the patient.

Ask, or know, their allergies. What number is your pain, have you taken pain pills before, or specifically ask, have you taken Percocet or Vicodin before. I tell my patients a little about the drugs, usually just that Percocet is a little stronger than Vicodin, what do they think, how bad is their pain? The patient and I discuss and decide together which to use.

You have to trust your gut, learn the "art of medicine." A patient that is quiet, maybe stoic, not wanting to move much, but saying they really don't need anything, could be in a lot of pain. You need to teach them that moving, deep breathing, etc. is vital to their health. Is it their fear of drugs being too strong, or becoming addicted, that prevents their asking for pain pills?

Up Vote Up Vote ×

I agree with asking the patient. Especially if it is a repeat birth, they may know what worked and what didn't last time. I was given morphine via a PCA with my first c-section and got violently ill. Also Lortab will make me sick (nausea/vomiting), but percocet and vicoprofen don't. I made sure they knew this when I was admitted for my second c-section.

Up Vote Up Vote ×
Specializes in Community, OB, Nursery.

Asking the pt is always a good idea. Our routine post-op C/S orders allow us to give 1-2 Norco q4 prn while epidural/Duramorph is still in effect for breakthrough pain. We rarely use it, since we also give Toradol in the first 24 hours, but it is there in case.

After that we give around-the-clock Percocet 1-2tabs q4 x 24, and we can also start Motrin 600mg q6. When that is up, the Percocet goes to prn. These are our default orders. If the pt has an allergy or a different preference, we can always get an order for something different. But most people do alright on the Percocet, and some even say the Percocet works better than the epidural/Duramorph (very rarely do we use PCA).

ETA - we use prn Motrin and Percocet for vag deliveries. But very rarely do we send a SVD mom home with Percocet. It has to be pretty drastic - like a 4th-degree tear or a separated symphysis before they'll do that.

Up Vote Up Vote ×
Specializes in OB-Gyn/Primary Care/Ambulatory Leadership.

What is Norco? I've never heard of that.

We give Percocet, Roxicet, or T3, as far as narcotics go. For NSAIDs we give Toradol or Motrin.

Up Vote Up Vote ×
Specializes in OB.

Norco is the new Vicodin, it only has 325 mg of Tylenol instead of the old 500 mg.

Up Vote Up Vote ×
Specializes in OB-Gyn/Primary Care/Ambulatory Leadership.
Norco is the new Vicodin, it only has 325 mg of Tylenol instead of the old 500 mg.

So is the main difference between Norco and Percocet simply that of oxycodone vs. hydrocodone?

Up Vote Up Vote ×
Specializes in NICU, previously Mother baby.

It's interesting to see how facilities differ in pain management.

We give lady partsl deliveries 800mg ibuprofen q8hrs, and for break through pain they can have norco 7.5/325 q3hrs prn.

C-sections get 800mg ibuprofen q8hrs, and for break through pain they can have percocet (1-2 tabs) prn and oxycodone (1 tab with 1 percocet) prn q3-4hrs depending on the combination they use.

We VERY rarely use PCAs unless the patient underwent general anesthesia. Toradol is used once in a while, but almost always as a 1x dose.

Our patients are typically eating within an hour or two of being on the floor, so they can start their oral pain meds at that time.

Up Vote Up Vote ×
Specializes in OB-Gyn/Primary Care/Ambulatory Leadership.
We VERY rarely use PCAs unless the patient underwent general anesthesia. Toradol is used once in a while, but almost always as a 1x dose..

Let me guess - do your anesthesiologists use Duramorph in their spinals?

The first hospital I worked at always had PCAs for s/p C/S pts. When I came to the hospital I work at now, I was appalled that they didn't give PCAs. WTHeck? I'm sorry, but q6h Toradol won't cut it! Then I discovered the reason WHY the pts didn't need PCAs - they got Duramorph in their spinals, which pretty much knocks most of the pain out for most people for 12-24 hours. The first facility I worked at did not use Duramorph. Therein lies the difference.

Up Vote Up Vote ×
Specializes in NICU, previously Mother baby.
Let me guess - do your anesthesiologists use Duramorph in their spinals?

The first hospital I worked at always had PCAs for s/p C/S pts. When I came to the hospital I work at now, I was appalled that they didn't give PCAs. WTHeck? I'm sorry, but q6h Toradol won't cut it! Then I discovered the reason WHY the pts didn't need PCAs - they got Duramorph in their spinals, which pretty much knocks most of the pain out for most people for 12-24 hours. The first facility I worked at did not use Duramorph. Therein lies the difference.

Yes. It's great stuff! :)

Up Vote Up Vote ×
+ Add a Comment