Duramorph/astromorph for C/S

Is this being given IV or in the spinal?

I'm just finishing up my maternity rotation at a community hospital, and here's how it goes there w/Astromorph ...

It's given before the spinal is d/c'd. Standard orders include continuous pulse ox monitoring and assessment of respirations & alertness q 1 hour x 12 hours, then q 4 hrs. for the next 12 hours. Motrin 600 mg q 6 hours x 4, but no narcotics for break-through pain without consultation w/anesthesia. Pts. sometimes have nausea, but the biggest complaint is upper body & upper extremity itching - IV Benadryl is included in the orders.

Hope this helps. :)

We do like MLOS says. Duramorph for spinal use; have to monitor respers and Sats for 24 hours. Foley Catheter stays in 24 hours, to ensure innervation comes back fully so mom can urinate on her own. Narc's given only with consult w/anesthesia personnel.

We use duramorph very seldom now. I resurrected a policy. We did checks every hour x 24 for resp and loc. Big problem with itching and some nausea. and it wore off in about 14-18 hours. Often put nubain in the IV for itching seems to me.

Karen

We have a new group of anestesiologists that are starting to use Astromorph or duramorph for our C/S. Does anyone have a policy regarding care of these patients post-op?? We are looking for information regarding frequency of vitals, need for pulse ox, narcotic orders or other pain meds etc. Any help you can give would be greatly appreciated. I remember when we used to do this about 15 years ago and we did respirations every 15 minutes for about 12 hours!!! It seemed ridiculous. Thanks in advance. Sharon

We use duramorph very seldom now. I resurrected a policy. We did checks every hour x 24 for resp and loc. Big problem with itching and some nausea. and it wore off in about 14-18 hours. Often put nubain in the IV for itching seems to me.

Karen

We have a new group of anestesiologists that are starting to use Astromorph or duramorph for our C/S. Does anyone have a policy regarding care of these patients post-op?? We are looking for information regarding frequency of vitals, need for pulse ox, narcotic orders or other pain meds etc. Any help you can give would be greatly appreciated. I remember when we used to do this about 15 years ago and we did respirations every 15 minutes for about 12 hours!!! It seemed ridiculous. Thanks in advance. Sharon

our anesthesia guys went through a Duramorph phase both for labor intrathecal/epidurals and C/S spinals.

It was occasionally very effective at pain control, but overwhelmingly uncomfortable to the patient as far as itching and vomiting. Benadryl and/or Nubain IV and cool compresses to the itchiest spots help with the itching but the vomiting left our patients more sore (especially post op sections).

We didn't have a policy that required us to monitor patients who had Duramorph any differently than patients who didn't. We'd do the "sneak and peak" to check respirations though.

We kept a log of everyone who c/o itching or vomiting post Duramorph and when presented with that, everyone in anestesia discontinued it's use except for the one doc who was already using it. I don't know if it's technique or what but patients don't have as much vomiting with his duramorph spinals.

our anesthesia guys went through a Duramorph phase both for labor intrathecal/epidurals and C/S spinals.

It was occasionally very effective at pain control, but overwhelmingly uncomfortable to the patient as far as itching and vomiting. Benadryl and/or Nubain IV and cool compresses to the itchiest spots help with the itching but the vomiting left our patients more sore (especially post op sections).

We didn't have a policy that required us to monitor patients who had Duramorph any differently than patients who didn't. We'd do the "sneak and peak" to check respirations though.

We kept a log of everyone who c/o itching or vomiting post Duramorph and when presented with that, everyone in anestesia discontinued it's use except for the one doc who was already using it. I don't know if it's technique or what but patients don't have as much vomiting with his duramorph spinals.

When I had my 2nd child in 1996, I had to be on a continuous apnea monitor for 24 hours. No pain meds were given unless the anesthesia provider was notified for that 24 hours. The anesthesia place bright orange stickers on on the front of the chart stating the patient was given intrathecal narcotics, etc. There is also a sign that is posted on the patient's door.

That policy is still in place. I have friends who work in OB. Intrathecal narcotics are also used for post AAA surgery in ICU.

One hospital locally had a post c-section patient die after recieving intrathecal narcotics. She figured out how to disable the apnea monitor because the noise was bothering her. Educating your patients on the importance of the apnea monitor is crucial.

Intrathecal narcotics are also used for labor patients, not just surgical patients.

When I had my 2nd child in 1996, I had to be on a continuous apnea monitor for 24 hours. No pain meds were given unless the anesthesia provider was notified for that 24 hours. The anesthesia place bright orange stickers on on the front of the chart stating the patient was given intrathecal narcotics, etc. There is also a sign that is posted on the patient's door.

That policy is still in place. I have friends who work in OB. Intrathecal narcotics are also used for post AAA surgery in ICU.

One hospital locally had a post c-section patient die after recieving intrathecal narcotics. She figured out how to disable the apnea monitor because the noise was bothering her. Educating your patients on the importance of the apnea monitor is crucial.

Intrathecal narcotics are also used for labor patients, not just surgical patients.

IV narcan works great to decrease the itching, N/V, ect that accompany neuraxial opioids.