Benadryl use with Dilaudid.. just curious!

[mandaaRN]

Just trying to learn about the use of Benadryl and Dilaudid.

Is benadryl usually given before Dilaudid or after? And why is it used with Dilaudid?

I know itchy skin can be a side effect, but what are some other alternative nursing interventions to relieve itching?

Thanks so much!

[FancypantsRN]

I give it before the dilaudid - it is given for the side effect of itching. I can't think of a nursing intervention that will help the itchies other than benadryl.

[Flo., BSN, RN]

If the pt is known to need it, I give it at the same time. That way I don't forget one or the other if I get busy.

[rn/writer, RN]

I work postpartum, so I frequently see c-section patients on PCAs with dilaudid. Itching is a frequent side effect of dilaudid and is usually benign but highly irritating. I give Benadryl as soon as the patient complains, because it's only going to get worse. Most of the time there is no visible rash, and even if you see irritation, it could very well be from the patient's vigorous scratching.

As far as, " alternative nursing interventions to relieve itching," I'm not aware of anything that works as effectively as Benadryl. Itching, if it's strong enough, can be more aggravating than pain. It can disturb sleep, interfere with breastfeeding, and take an otherwise pleasant person and make her a little nuts. I might sometimes encourage a patient to shower if I know she's been sweating a lot, but seriously, nothing takes care of opiate-related itching quite like Benadryl.

In addition to helping with Dilaudid, Benadryl is usually the anesthesiologist's first choice to relieve itching related to Duramorph, which is what section patients get if they aren't put on a PCA.

[casi, ASN, RN]

I thought Benadryl with Dilaudid was just to increase the high

[rntj]

LOL! This question reminds me of my patients that come in with very convenient "allergies" to all pain meds except dilaudid, and oh yeah, also they need Phenergan for their nausea (only thing that works, right?) and don't forget the Benadryl for their itching. And they will want all three every four hours, watching that clock like a hawk. It's become such a common phenomenon at my work that we joke about it.

[psu_213, BSN, RN]

Somewhere in my mind I am thinking that I also heard benadryl increases the high. The times I have given it, the pt says dilaudid makes them incredible itchy, so it's done to prevent that. If it is ordered I give it either just before or just after the dilaudid...so essentially at the "same time."

[rn/writer, RN]

I don't worry too much about my PCA c-section patients getting high. Besides, I give the Benadryl s-l-o-w-l-y. You know what they're after when they ask you to push it fast.

[Ozzybear]

The patients on my unit that have PCAs also usually have a narcan drip ordered to help with itching. Benadryl doesn't always relieve the itching and you have to wait several hours between doses. Some patients do still like their benadryl. The slower you run it the less of that "high" they feel but yeah that is why a lot of patients want it.

[rn/writer, RN]

Postpartum patients on Duramorph have Narcan listed, but most of the docs want us to give Benadryl first. We don't have Narcan ordered for PCA patients.

[JessiekRN]

The patients on my unit that have PCAs also usually have a narcan drip ordered to help with itching. Benadryl doesn't always relieve the itching and you have to wait several hours between doses. Some patients do still like their benadryl. The slower you run it the less of that "high" they feel but yeah that is why a lot of patients want it.

I've never heard of Narcan being indicated for itching..as I understood it Narcan is an opioid reversal..can you explain to me the purpose of Narcan being dripped with a Pca? Seems to me that the Narcan would cancel the effects of the PCA..I'm confused.

[Ozzybear]

I should have probably clarified that I am not on a postpartum unit.