fentanyl in labor

[ldcmw1]

Hello,

I anybody using fentanyl for pain relief in labor? If so, how much is used. How often and does it work well? What effects do you see on the baby?

Thanks,

ldcmw

[feebebe23]

Once had some EMT guys given a woman who was 10/10/2 50mics of fentanyl on the ambulance en route to the hospital.....she delivered 15 minutes later. What does the baby look like? Like it's talking to Jesus!

[LDRNMOMMY, BSN, RN]

It's our drug of choice! The docs write for 100 mcg q1hr x 6 doses. It doesn't seem to work for very long, 1 hr tops. That is what's pretty good about it as well, as long as you don't give it within about 30 minutes of delivery the baby usually does pretty well. At least that has been my experience.

[Conejita, BSN]

We use IV Fentanyl quite frequently for labor pain where I work. Our providers prefer Fentanyl for labor pain relief over other opiates because it decreases the likelihood of having to give the infant naloxone for respiratory depression after delivery. We rarely have issues with respiratory depression in the infant when using Fentanyl because it is shorter-acting than other opiates such as Morphine and Demerol. This is why Morphine and Demerol are only used in early labor at my facility, while Fentanyl can be given during active labor (but not second stage). We try not to give Fentanyl if we think the mother is within 45 minutes of delivering (which is not always easy to know) so as to reduce the possibility of respiratory depression in the infant after delivery.

Usually it is ordered by the MDs/CNMs as 50-100mcg IVP every 30-60 minutes. We also have one MD who almost always orders it to be given in a PCA with a basal rate, which has its pros and cons. In my experience administering Fentanyl, the first dose always seems to work the best and last the longest, with decreasing efficacy in subsequent doses. I have had some laboring moms love it because it was enough to keep them from getting an epidural that they didn't want....and others who hardly felt any relief at all and couldn't wait to get an epidural/intrathecal. The most frequent side effect for the mom that I've noticed is dizziness.

As for fetal effects, we often see decreased variability of the FHR for a short time after administration.

One other side effect, often reported anecdotally by our RNs, is early breastfeeding difficulties with babies exposed to IV Fentanyl during labor. This usually takes the form of a sleepy babe w/ an uncoordinated suck. I would expect that all IV opiates would have a similar effect on alertness and coordination in the newborn.

[HappyNurse2005, RN]

We used to use Stadol 1mg/Phenergan 25mg when i started in labor 3.5 years ago. Now, its Fentanyl 100mcg q1hr prn. some docs dont like multips to have it after 6cm. some dont care if she gets it 5 mins before she delivered.

ahd a multip come in to hospital at anterior lip. (she didnt plan it that way).

she screamed that she needed drugs, she wasn't doing it without drugs, and very insistent. So I gave her 100mcg Fentanyl, she delivered one minute later, baby was fine, and she felt the relief after the baby was already out :)

[HeartsOpenWide, RN]

The Anesthesiologist use Fentanyl in their epidurals. We inject it into the I.V. but the docs order it as third choice...First try Nubain, then Stadol and last is Fentanyl.

[Elvish, BSN, DNP, RN, NP]

We use it a lot in our L&D and anecdotally, see far fewer babes with respiratory issues than with Nubain or Stadol.

[jctiabecerra]

Fentanyl is the only pain medication we give to our laboring patients. We usually give 100mcg q1-2 hrs until 8-9 cm. If the patient becomes complete within an hour of a dose we give Narcan to the mother and have a vial ready for the baby if needed. In 8 years I have only had to use Narcan onthe baby twice.

[elanddeenrs]

this is so interesting to me... at my facility we're not allowed to push Fentanyl IV because it is considered conscious sedation, and they have to be monitored via EKG, which we don't have the capability of in our L&D. We usually use Stadol of Nubain. We have one MD who uses a "cocktail" of Nubain IV, Vistaril IM, and Vistaril PO. It's very effective and long lasting.