Duramorph (intrathecal)

[smmc]

What unit or department do patients who have received Duramorph (intrathecal morphine) during spinal surgery go post-op. If ICU, how long? If general ortho, what precautions or special care is required?

[monica f]

Our facility it's atleast 48 hours......most of the time longer

[GJBOUSHLEY]

At our hospital spinal surgery have never been given duramorph but our ortho patient do on a regular basis. These patients go to recovery for 45-60 min post-op and then return to the ortho unit. Our anesthesiologist have standard post-op oders that are in effect for 24 hours post-op. These orders cover O2 if needed and oximetry checks or continuous oximetry, resp q 1hr x 16 hours, all post-op narcotics that are ordered are cut in half and can repeat in 1 hour for break through pain. We have mediactions to cover itching and nausea that are common side effects.Hope this helps.

[nurhmb]

We use narcan IV for itching. It is titrated to a rate that controls the itch but continues to maximize the analgesia. In a pinch at night, if things are caught up in pharmacy, we will use a dose of nubain IV IV (2.5mg) every 15 minutes until things get settled or the patient is comfortable.

We use Zofran for nausea to avoid the sedation issues of things like phenergan.

We have a physician order sheet that covers all monitoring etc. so the nurses have a standard format of behaviour and can anticpate their actions.

[nurhmb]

We use narcan IV for itching. It is titrated to a rate that controls the itch but continues to maximize the analgesia. In a pinch at night, if things are caught up in pharmacy, we will use a dose of nubain IV IV (2.5mg) every 15 minutes until things get settled or the patient is comfortable.

We use Zofran for nausea to avoid the sedation issues of things like phenergan.

We have a physician order sheet that covers all monitoring etc. so the nurses have a standard format of behaviour and can anticpate their actions.

[P_RN, ADN, RN]

We did intrathecals for about a year, but when the state board posted an opinion that it was not within the practice of an RN....we stopped. I never had problems with them, but one of our nurses was thinking epidural and bolused with nearly 10x the intrathecal dose......Narcan...and the patient was fine. And he got his catheter out right then. Epidurals are what most use. Rarely at all a plain one shot spinal.

What the above posters wrote matches my experience. Twenty-four hours is the max from most surgeons. Patients come to our general orthopaedic floor. Standardized orders with anaesthesia always in house on call. For pruritus Benadryl, a bit of Narcan for itching. We could bolus and change rates. For nausea Inapsine (I know not anymore, but back then we did). Zofran cost like a bajillion$ and it was only allowed for cancer patients. Again I know that has changed.

[chelsea_j]

they come to our ortho/neuro unit. They have pulse ox and no narcs for 18 hours

[suehp]

they come to our ortho/neuro unit. They have pulse ox and no narcs for 18 hours

We have continious pulse ox for 24 hours and no narcs in that time either.

[DGMLPN]

Is it normal to have 48 hour protocols on post-op narcs after durmorph intrathecal?

[Ann RN]

What unit or department do patients who have received Duramorph (intrathecal morphine) during spinal surgery go post-op. If ICU, how long? If general ortho, what precautions or special care is required?

The above poster (DGMLPN) first posted in the General Nursing Discussion, asking if her personal experience with a duramorph epidural could be considered malpractice. I'd be careful in your posts here.

[DGMLPN]

I know...sorry....not trying to get anyone in trouble...first time here and just a Low Paid Nurse

[DGMLPN]

Have any of your patients developed an ileus or Irritable Bowel Syndrome from duramorph admin?