Duramorph/astromorph for C/S

JenTheRN · Oct 9, 2004

Is this being given IV or in the spinal?

Altra, BSN, RN · Oct 9, 2004

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. :)

SmilingBluEyes · Oct 9, 2004

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.

KKRJJ · Oct 10, 2004

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

KKRJJ · Oct 10, 2004

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

palesarah · Oct 10, 2004

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.

palesarah · Oct 10, 2004

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.

Long Term Care Columnist / Guide · Oct 10, 2004

Years ago when I had my last child, Duramorph was just coming into vogue at my hospital. My nurse-anesthetist told me I would probably be very pleased with the pain relief, which I was---in fact, I had NONE for the first 24 hours post-op---but I almost clawed my face off!! Doesn't sound like that's changed much over the years.......too bad, because that was the best pain control I ever had. But the itching was just unbearable, and none of the modalities available at the time did more than calm it down a bit. Frankly, I'd rather have some pain than that infernal itching.......can't they make Duramorph with some sort of antihistamine, I wonder, since it's such a common reaction??

Long Term Care Columnist / Guide · Oct 10, 2004

Years ago when I had my last child, Duramorph was just coming into vogue at my hospital. My nurse-anesthetist told me I would probably be very pleased with the pain relief, which I was---in fact, I had NONE for the first 24 hours post-op---but I almost clawed my face off!! Doesn't sound like that's changed much over the years.......too bad, because that was the best pain control I ever had. But the itching was just unbearable, and none of the modalities available at the time did more than calm it down a bit. Frankly, I'd rather have some pain than that infernal itching.......can't they make Duramorph with some sort of antihistamine, I wonder, since it's such a common reaction??

SuperSGirl · Oct 10, 2004

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.

SuperSGirl · Oct 10, 2004

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.