Does your unit use spinals?

ragingmomster, BSN, MSN, RN · Jun 20, 2006

We use spinals mainly for c-sections. We have one or two ologists who use a combined spinal/epidural and I have found that in greater than 50% of their cases when the spinal wears off the epidural is useless.

The amount of medication in the spinal is not the issue with spinal headaches, it's the amount of CSF leakage.

mitchsmom · Jun 20, 2006

yeah...hmmm wonder what she meant then? Do they use a smaller needle to administer it since it's a "smaller amount of medication", thus less leakage??

I think alot of the spinals in our case are for labor period, whether c/s or not. I just didn't think spinals were that big any more so I'm wondering why they are using them a lot there. The "ologists" are a variety of ages so I don't think it's a time warp?

SmilingBluEyes · Jun 20, 2006

Duramorph spinals are used in my hospital for planned/elective csections, by all except one MDA. Only have seen ONE headache in 7 years related to spinal/wet tap. And it was an epidural, not a planned spinal.

OBNurseryRN2006 · Jun 20, 2006

We do intrathecals for relief of labor pain, which is a spinal shot. We use duramorph and fentanyl, the OB's and FP dr.'s do them on their patients - they all have been specially trained. We do not offer epidurals at our facility and only just started offering intrathecals about 15mos ago. Have only seen one real spinal HA in that time, r/t the intrathecal. Seems they work OK, but seems that the side effects (itching, urinary retention, n/v) are quite bothersome to about 90% of pts for along time after delivery.

OBNursery2006 :lol2:

CEG · Jun 21, 2006

I had intrathecals with both of my labors. They took the pain away completely for an hour or two, then it crept back in. I still had the urge to push and was able to walk/ move around.

I had a lot of nausea and vomiting with my first but not with my second. I definitely did not want an epidural so I was very happy with it.

I had the intrathecal at the recommendation of my CNM.

nurseob7 · Jun 21, 2006

We only use spinals for c-sections ----unless the pt already has an epidural in place, then the anesthesiologist will use that for the section.

Epidurals are extremely popular on my unit. I would say app 80-90% of all first time moms get an epidural. Most multips also request them, but occas deliver too quickly to get one.

BabyRN2Be · Jun 21, 2006

We use spinals mainly for c-sections. We have one or two ologists who use a combined spinal/epidural and I have found that in greater than 50% of their cases when the spinal wears off the epidural is useless.

I have found that to be true as well. Some of the anesthesiologists were using the combination epidural/spinal and we had sooo many patients who were not getting any pain relief when the spinal wore off. It drove the nurses crazy, and this group was repeatedly told about the problem, but they swore up and down that it couldn't possibly be due to the combination.

It really made me mad that patients were not getting adequate pain relief during labor. :angryfire

SmilingBluEyes · Jun 22, 2006

Couple of our MDAs actually place intrathecal, inject meds and then complete procedure with epidural and pump. This is the HEAT. Patients get relief almost immediately, and the relief stays til epidural is D/C'd. I just LOVE IT.

Qwiigley, BSN, MSN, DNP, RN, CRNA · Feb 5, 2008

I'm a CRNA. I usually use a PCEA (epidural) for all of my patients that request pain relief. It works alot like a PCA (IV) only this is via the epidural.

I use a base rate titrated to the patient's height (epidurals and spinals are dosed per pt ht). They then can give themselves 5ml boluses q 15 min up to the max that I program in to the pump.

70% of the pain is gone, the pressure is tolerated well and they can all easily push their baby out when it comes time.

Rarely, but it does happen, I have to give an additional bolus beyond the programmed doses.

We have a pretty happy clientel.