Fentanyl for Labor Pain?

RMH · Jun 9, 2003

Our policy is that the MD should be in the room. We give it frequently to patients waiting to get an epidural, with good results..The MD's are wanting to use it more and more because of the short duration, so we are in the process of getting policy changed so Rn's can give it in labor without the MD being present. Of coorifice with O2 monitoring.

RMH

moonshadeau, ADN, BSN, MSN, RN, APN, NP, CNS · Jun 9, 2003

Cardiac nurse here not OB.

But as to putting the patient on a cardiac monitor, unless they have some sort of underlying cardiac condition that requires monitoring there is no reason to monitor. The fentanyl itself doesn't necessitate that you have to be monitored. Unless you are planning on slamming it in. The only side effects that are cardiac related are hypotension and bradycardia. Both of which you should have a good idea of what the range is before you give it.

If the Fentanyl is given post-anesthesia, then the patient should be monitored because it of the increased risk of arrythmias, and pressure control.

As far as my facility, I know they give it because they offered it to me as one of my choices. I know that they do not cardiac monitor the patients whom they give it to, because my cardiac unit is the only floor that is able to monitor.

Any analgesic should have pulse ox monitoring with frequent dosing.

mother/babyRN, RN · Jun 10, 2003

Have seen several patients respiratory arrest with fentanyl. Must be my bad luck.......See, one learns something every day around here...

kmchugh · Jun 10, 2003

Fentanyl is a narcotic, and like any other narcotic, it has some side effects. It is a particularly potent narcotic, hence is dosed in micrograms, rather than milligrams. Once you become familiar with it, you should be no more or less comfortable using it as you would be using morphine.

We use fentanyl quite a bit in anesthesia, because it is more potent, and shorter acting than quite a few other narcotics. It also, in large enough doses, can cause chest wall rigidity, making it impossible for the patient to breathe. But, the necessary dose to cause this is much higher than any of the doses you have listed.

One particular advantage to fentanyl is that it IS short acting. If you give it to mom, and that dose gets to baby, with delivery ensuing shortly thereafter, the baby will metabolize the dose of fentanyl s/he received fairly quickly.

Kevin McHugh, CRNA

layna · Jun 10, 2003

Thank-you all for your input so far!

Kevin, will the fetus store the Fentanyl in his/her fat cells for some time after delivery? I have heard this and cannot find much literature related to this.

Layna

mother/babyRN, RN · Jun 10, 2003

I know all about fentanyl, believe me...Enough to know that I would prefer anesthesia be responsible for administration..I was also a cardiac nurse way back when........

beepers40 · Jun 10, 2003

Fentanyl IVP is our first-line narcotic. Standard orders are 50-100mcg IVP Q1-2 hrs. No special O2 or other mommy VS monitoring, just FHR and toco. Works really well, wears off fast, babies do really well with it, too. Take effect immediately. Mommies don't usually like the dizzy feeling they get at first, but generally are quite happy with the relief they get. Our facility also uses fentanyl for epidurals. Rarely do we use nubain or stadol.

mother/babyRN, RN · Jun 20, 2003

Well, I still have some reservations but am open to it should it come our way..

Burr · Jun 29, 2003

Just 2 nights ago one of our doctors demanded that 100mcq be given to a laboring woman who had only a lip remaining. I got the drug out of the locked cabinet and stated that it was on the shelf behind her. I would not have given it, and will not give it in the future. Do not trust her, or her judgement. When she realized that it was there and just how much she was ordering - she looked at the container and decided that she would not be able to give it to her. As a nurse we DO have the RIGHT and Responsibility to object and challenge and refuse to give a drug that is unsafe - or that we have not had the research on.

Then later I heard that she was discussed with those of us who dear to question any of her judgements.

It is my licence and moral responsibility to make sure that my patient is safe. They can take my JOB but not my beliefs.

Sorry for venting with the reply. Have any of you given 100mcq IV. Our epidurals dosages are mixed with 50 for a continuous infusion - but is monitored by anestesia, and can be stopped at any time. What do you think?

finallyRN · Aug 17, 2003

We regularly give fentanyl at my facility. I think it works really good on most patients. We as RNs are allowed to give it. They do not need any cardiac monitor. As far as i know there have been no adverse effects on our unit it the 3 years i have been working there

Dave ARNP · Sep 20, 2003

Okay, I have multiple response, so this will be sorta... Lengthy?

But anyone who knows me well, knows I elaborate :-D

I say we are a small hospital. I've been told thats wrong. Admin. tells me we're large, because we do Heart Surgery. Big woop! 156 beds says to me we're small!

However, we do have some awesome practitioners who have top notch training and use the latest and greatest techniques.

Moreover, we have a killer nursing staff, who can adapt to these practitioners whims, and know when to tell them they're trying to re-invent the wheel :-D

Now... to your questions.

We do use Fentanyl in L&D. It's been used for a couple of years, and they really like it. Starting does is 25mcg IVP Q1hr. They go up to 100mcg IVP Q1hr. This is if ordered by an OB doc. (I say this, because my MD and I do it differently, and I'll talk about that in a moment).

There are a set of IV Pain meds that they use in L&D. These are the only drugs that the docs use. This is because of hospital policy, MD policy, and various other reasons.

Drugs are as follows:

Fentanyl

Nubain

Stadol

Dilaudid (Availble, but my wife who is the Chief of Ob/Gyn says it is rarely used)

Now...

As I have mentioned before, the MD I work with and myself do alot of Pain Management in our regular Family Practice. In doing this, we have set up a protocol for using IV Pain Medication, and it has become hospital policy. It covers what to do when a patient is both in pain, and the monitoring that is required of the nurse when admin. the medication IVP. I beleive this would be easily applied to OB, or any other speciality.

Case:

Patient is admitted with cronic pain.

Orders are for MSO4 PCA, 6mg Basal w/ 1mg Q6min PRN

Orders are also for Fentanyl Per Protocol.

Nurse arrives in PT room. NSIV line is running. Pain assessment reveals pain to be a 8 of 10. Per protocol, Nurse administers 20mg of Fentanyl.

Nurse stays at bedside, monitoring PT. BP is monitored Q 1min, Resp Q 30second, Pulse contin., nurse listens to lungs to assess depth of resp, and SPO2 is constantly monitored.

At 4minute mark, Pt states Pain is a 7. Per protocol, Nurse administers 16mg of Fentanyl. Monit. is repeated for 6min.

This is done, until pain is at a level 3 or less.

At this point, the MSO4 via PCA is started.

David Adams, ARNP

-ACNP, FNP

trogdor · Sep 24, 2003

At our hospital we use 100mcg fent q 1 hr, up to 3 doses, or until the pt is 7-8cm. I find that the 1st dose usually works great, but the 2nd and 3rd doses don't seem to work as well. We don't ever have on a sat monitor or cardiac monitor for fent. administration, and have never had a problem in the facility with it. Some CNM want us to use nubain, but I have never seen it work well. For my labor I had stadol, and it worked great for my early labor, until I was able to get an epidural.