Duramorph/astromorph for C/S

[babies_r_us]

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

[charles-thor]

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

[charles-thor]

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

[imenid37]

Itching! It can be awful. A narcan drip can help, but can also decrease pain relief. Nubain seems to work better for the itching w/o decreased pain relief. We actually had pt's wear an apnea monitor post-duramorph. That was 10-12 years ago.

[imenid37]

Itching! It can be awful. A narcan drip can help, but can also decrease pain relief. Nubain seems to work better for the itching w/o decreased pain relief. We actually had pt's wear an apnea monitor post-duramorph. That was 10-12 years ago.

[BETSRN]

Duramorph is the medication in the a spinal for a section where I work.It works great. Most common side effect is intense facial itching. We often use IV Narcan to ease the itch. Our sections can get OOB whenever they want: often the same day as their surgery and for sure the next morning. IV and foley come out and the patient is gotten up into the shower. Usually, they are flying straight by then!

[BETSRN]

Duramorph is the medication in the a spinal for a section where I work.It works great. Most common side effect is intense facial itching. We often use IV Narcan to ease the itch. Our sections can get OOB whenever they want: often the same day as their surgery and for sure the next morning. IV and foley come out and the patient is gotten up into the shower. Usually, they are flying straight by then!

[babies_r_us, RN]

My patient never had any itching and did actually receive good pain relief. The other problem I ran in to was if she had needed other pain meds, the anestesiologist refused to order since "he wasn't the primary" and the primary physician refused to order any since "the patient received duramorph". That was very frustrating also. Like I said, she had excellent pain relief so luckily I didn't have to worry about that. Thanks for all your help.

[babies_r_us, RN]

My patient never had any itching and did actually receive good pain relief. The other problem I ran in to was if she had needed other pain meds, the anestesiologist refused to order since "he wasn't the primary" and the primary physician refused to order any since "the patient received duramorph". That was very frustrating also. Like I said, she had excellent pain relief so luckily I didn't have to worry about that. Thanks for all your help.

[Burnt Out, ASN, RN]

When I had my C-section in June 2002, I had Duramorph in my spinal. I remember my nurse coming in Q 2 hours to check on-I didn't have a sat monitor or anything. The pain relief was great-yes, I had soreness, but as far as pain...that didn't start until well over 24 hours after my section. But I had horrible itching all over my face, my arms and my back! They gave me Nubain 5 mg for the itching and it helped some...but what really helped was Benadryl 50 mg po! Plus I begged any family who came in my room to "scratch my back!" :chuckle

[Burnt Out, ASN, RN]

When I had my C-section in June 2002, I had Duramorph in my spinal. I remember my nurse coming in Q 2 hours to check on-I didn't have a sat monitor or anything. The pain relief was great-yes, I had soreness, but as far as pain...that didn't start until well over 24 hours after my section. But I had horrible itching all over my face, my arms and my back! They gave me Nubain 5 mg for the itching and it helped some...but what really helped was Benadryl 50 mg po! Plus I begged any family who came in my room to "scratch my back!" :chuckle

[Jolie, BSN]

Way back in the early '90's, our anesthesiologists stopped using Duramorph for C-sections because of it's side-effects. It either seemed to work great for post-op pain, or not at all. And in the patients who got good pain relief, the incidence of severe itching was so high that it was decided that Duramorph was no longer going to be used.

It was replaced by continuous epidural infusion set up on a PCA pump. During surgery and for the first 8 hours thereafter, the patients were given a combination of a "-caine" drug along with fentanyl. After 8 hours, the cassette was changed to a plain "-caine" drug. The pump was set up with a continuous baseline infusion, along with a PCA component. The moms got wonderful pain relief, were up and walking within hours of their sections, and had no problems with itching.

We did hourly respirations and used O2 sat monitors as well, for the first 12 hours, I believe.

[USA987, MSN, RN, NP]

We use Duramorph. Our policy is q1hr vitals x 4, then q4hrsx5, then q8hrs. IV and foley stay in usually 18-24 hrs. Toradol IV or Tylox po is given for breakthrough pain...if you need anything else in the 1st 12 hrs. you must obtain an order from anesthesia. Itching seems to be the biggest problem for us...

Some of our docs tried that pain control device that has real thin tubing that goes under the suture line, and the pt. would receive continous flow up pain meds...but that only lasted a few days...