Dilaudid Question

renerian, BSN, RN · Oct 25, 2002

I have done 4mg IVP for acute pain or pre procedure on a hem/onc/bmt unit.

renerian

Y2KRN · Oct 25, 2002

Thank you so much for your reply, I had a Doc. order 6mg IV for someone with chronic pain, to be repeated x 2. I just thought that this may be a lot considering the comparison to morphine doses.

Again thank you.

P.S. This was a non-cancer patient.

kaycee · Oct 25, 2002

2mg has been max for me as a one time dose for pain control. However I have closely followed that dose in increments of 1mg until pain was controlled or the pt was zonked.

**canoehead, BSN, RN** · Oct 25, 2002

I would give as much as the patient has shown the ability to tolerate. If it took 10mg to relieve their pain before I would have no problem giving 6mg initially, and then one at a time until pain was relieved.

Otherwise 1mg at a time.

kids · Oct 25, 2002

Originally posted by Y2KRN
Thank you so much for your reply, I had a Doc. order 6mg IV for someone with chronic pain, to be repeated x 2. I just thought that this may be a lot considering the comparison to morphine doses.

Again thank you.

P.S. This was a non-cancer patient.

My guess is the patient is drug tolerant as a result of pain meds to treat the chronic pain.

I am on meds for chronic pain and have consistantly had problems with post op pain management...because the nurses (very appropriately) question the dosage or because the surgeon has no clue of how to prescribe parenteral MS for someone who takes 300 mg/day for maintanence- usually I can prevail upon the doc to involve the pharmasist but once my family did have to call my pain clinic doc in to "save me" followind an emergancy open lap (I was nonverval, puking, twitching and moaning).

meandragonbrett · Oct 26, 2002

Since i've been volunteering, we've only given it once via IVP. It was a big ordeal because it's always ordered IM at my hospital.

Brett

traumarns · Oct 26, 2002

Have had rsd pts with spinal stim placement require dilauded 4mg q8-10mins via pca, then ask for their bolus's of 10mg q 4hrs.

the one pt that i totally remember was up walking around, talking, no extra o2 requirements.(however i did have him wear nc at 2L just cause he was on so much) hemodynamically stable. as soon as the doc turned his stimulator on. he required barely 1/2 of the dose of dilauded he had been taking. we titrated the dilauded down slowly. and a few days later switched him to oral and he went buh by to home.

just for the record, the gentleman was not just on opiates for pain. he was on BOTH depakote and neurontin.

RutgerskidBSN · Oct 26, 2002

Working for a hospice pharmacy I have seen Dilaudid Iv push up to 10mg q1-2h. This not often seen in most pt's. This particular pt had Lung Ca with mets to Brain and Bone, and was admitted back into the hospital. Besides end of life care, i have never seen it this high. I hope this helps.

Kevin

KarafromPhilly · Oct 26, 2002

Brett--if I remember correctly, IM dosing is considered dangerous because of variable rates of absorption, and it does not make sense in the management of acute pain anyway. Yes? No? Maybe so?

psychonurse · Oct 26, 2002

I haven't given much Dilaudid IVP much lately in my genre but I did have it on a PCA when I had my TAH/BSO and I was totally comfortable while on it for one day. I had only had it one other time post op but that was IM and it worked well both times.

meandragonbrett · Oct 27, 2002

Kara,

We give dilauded IM in the PACU all the time. I looked it up on http://www.rxlist.com and it didn't mention anything about it being dangerous.

http://www.rxlist.com/cgi/generic/hydromorphone_ids.htm

Brett