Fentanyl/Nubain use in labor

[K os]

Test Question Help

Which should the nurse administer first to a patient who desires IV pain medication in labor at 4 cm's?

a. Fentanyl

b. Nubain

Why:

[Elvish, BSN, DNP, RN, NP]

What do you think, and why? Not trying to be a smart aleck, but what have you thought of so far??

[K os]

Right now, I don't have too many thoughts about it other than would like an answer. Have been searching on web, textbook and notes etc. Final Exam in am, tired and would just like some help!!!

[RedCell]

You would give the nubain slick, OBs love this crap drug. Here is the basic watered down justification....It is a mixed opiate agonist/antagonist (look that up later dude). Agonist activity is on the kappa receptors with a higher rate of antagonism to the mu. Pain perception is altered because of the kappa agonism, but you don't get the full kick that you would from fentanyl. Nubain will still cross the placenta but will have less effect on the homewrecker stuck in her gut compared to the sublimaze. Should have a third choice.... epidural.

[Daytonite, BSN, RN]

Both are Pregnancy Category C drugs, but the Nubain has less side effects. Fentanyl is a Schedule II narcotic and Nubain isn't. Fentanyl causes cardiovascular complications including cardiac arrest, but Nubain doesn't. While both can cause respiratory depression, Fentanyl can cause respiratory arrest as well as laryngospasm but the Nubain doesn't. These are obvious effects on muscle. Labor involves muscular activity. 4cms of dilation is not even halfway to birth. The last thing you want to do is significantly slow the muscular contractions down any more than you have to.