C Section Post-Op Rx

maggie0, BSN, RN · May 16, 2017

It sounds like pain management has improved since I had my last c-section, in 2000. I got zippo after the IV came out. When it was time to go home, I said to the nurses, You know, getting in the car and riding home's really going to hurt. I was given a single pill of something for the drive, walked into the house with my baby, and conked out. And that was that.

serenity1 · May 16, 2017

Our C-sections get the 1 gram of Ofirmev and 30 mg of Toradol in the pacu. They usually get Toradol every 6 hours and Percocet every 4 hours for the first 24 hours and then switch over to Norco and Motrin until discharge. The only time our mom's get a PCA is if they have general anesthesia or are opioid dependent, and they usually only have it 12-24 hours.

klone, MSN, RN · May 16, 2017

My wife had c section with twins and she was on either a fentanyl or dilaudid PCA for 2 days, then switched to norco 10 for home. She had a lot of pain from her c section. Tylenol/toradol didn't do much for her.

A lot depends on the type of spinal/epidural that is given. If the epidural is duramorph, it generally precludes the need for a PCA. It offers long-lasting pain relief, usually for 24-36 hours post-op.

Mkakids · May 17, 2017

Personal experience here. I have had 2 c/s and both times received only Norco once out of surgery (no PCA) and was discharged 2 days post op with 600mg Mortin only.

Kooky Korky, BSN, RN · May 18, 2017

I doubt a narcotic would be started on PO Day 3 after discharge for most moms.

My niece had a CS. She was given Toradol IV, although I thought she was receiving some narcotic. She was expected to care for herself and for baby - lifting him in and out of the bassinet, etc. after having been sliced open.

She was still in the hospital on POD 3. On POD 3, she was put on oral Rx - Percocet.

LovingLife123 · May 18, 2017

I was given Percocet after the epidural wore off. I can't imagine toradol being the main pain mgmt immediately post op and then switching to a narcotic. I would think narcotic post op and then just an NSAID when discharged.

Meriwhen, ASN, BSN, MSN, RN · May 18, 2017

Not a OR or OB nurse...

For my own C-section, I was given Toradol. Opiates were not an option because I react horribly to them (I was probably the first patient the nurse ever came across that screamed "NO!" when offered Percocet post-surgery. If she is reading this, I'm truly sorry about that).

I got Toradol while inpatient, and was switched to an ibuprofen/acetaminophen regimen at discharge.

quazar · May 18, 2017

My niece had a CS. She was given Toradol IV, although I thought she was receiving some narcotic. She was expected to care for herself and for baby - lifting him in and out of the bassinet, etc. after having been sliced open.
She was still in the hospital on POD 3. On POD 3, she was put on oral Rx - Percocet.

I know this probably sounds evil, but it is normal to expect the mother to participate in and perform baby care after a c-section, even 1 or 2 days after. It's part of the care plan, in fact, to get the mother to participate in and take over care of her infant. Many hospitals are moving towards the model where there is no respite/"well baby" nursery, and babies stay with their mothers the entire time they are in hospital, even c-section moms. The nurses don't do all the care of the infant unless there is a medical reason why the mother cannot perform infant care (e.g., a mother on mag sulfate postpartum who is very sick and very lethargic and has no one with her to help).

morte, LPN, LVN · May 19, 2017

Because it has been proven safe (I actually worked as a mother baby nurse when some of the trials for this drug were going on to determine if it was safe for breastfeeding, among other things, way back in the day), and because it is excellent for post operative pain control.
A randomized, controlled trial to compare ketorolac tromethamine versus placebo after cesarean section to reduce pain and narcotic usage. - PubMed - NCBI
Tips From Other Journals - American Family Physician

.

"safe" does not mean good nor efficacious.

and since it inhibit uterine contraction, how is it considered safe?

it is also contraindicated in nursing mothers.

klone, MSN, RN · May 19, 2017

.
"safe" does not mean good nor efficacious.
and since it inhibit uterine contraction, how is it considered safe?
it is also contraindicated in nursing mothers.

It's not found to increase risk of bleeding/hemorrhage, and it's highly effective for post-delivery uterine pain.

It is not contraindicated in breastfeeding women, not sure where you got that info.

quazar · May 19, 2017

.
"safe" does not mean good nor efficacious.
and since it inhibit uterine contraction, how is it considered safe?
it is also contraindicated in nursing mothers.

The pediatricians, obstetricians, midwives, and lactation consultants I work with all disagree with you, but okay. *shrug* Did you read the research?

quazar · May 19, 2017

Here, maybe this will help provide clarity. The AAP has a table of medications "usually compatible with breastfeeding" in this PDF. Table 6, starting on page 5.

http://pediatrics.aappublications.org/content/pediatrics/108/3/776.full.pdf

Here are 2 studies documenting the efficacy of toradol for post op cesarean pain relief, since that has also been called into question:

http://www.obstetanesthesia.com/article/S0959-289X(96)80069-0/fulltext

http://www.obstetanesthesia.com/article/S0959-289X(07)00017-9/fulltext

I'm not sure what your level of bedside obstetric experience is, and why you have such discomfort with toradol, but the research backs up the practice. Don't know what else to tell you here.