How much Fentanyl??

We give 50-100 micrograms of fentanyl, usually to be repeated every hour. It does work well, but it doesn't last very long. Sometimes we will give the first dose with 25mg of IV benadryl, this seems to make it last a bit longer.

Molly

we never use either demerol or fentanyl for pain relief in pregnant women. They get stadol or nubain or an epidural. I am surprised anyone is using demerol these days in OB.

where I used to work,women in labor could get 50-100mcg of Fentanyl every 2-3 hours and had to be on a SAT monitor. Here, where I am now, it's simply not used except in the epidural itself.

I have also used Nubain in the past but was told at this place (I am new) that it has been taken off of the market a few times and they just never switched to it. I am also suprised that they still use Demerol and would like to try and change that.

We never use Fentanyl except in epidurals; we very commonly use 10 mg Nubain and 25 mg Phenergan for pain relief. I think there is one doc that orders Demerol and Phenergan.

Fentanyl 50-100 ug q 1 hr.

ALso use: Nubain 10 mg IV q 1-2 hr

Stadol 0.5-1 mg. IV q 1 hr.

Occasionally one doc orders Demerol 25-50 IV

Epidural standard infusion is 50cc bag, 3 ug/cc Fentanyl, Bupivicaine 1/8% in each cc, run 6-18 cc/hr

Occasional PCEA with 2 mg q 10-30

THe younger the anesthesiologist, the more potent the epidural bolus if needed for pain and the higher the rate (I think its because their wives had babies :)

50-100 Fentanyl Q 1 hour prn: It's good for short term relief and the great thing about it is that it's pretty much gone after an hour. If you time it right you don't have floppy babies.

As for Demerol in my experience it's not so great although I have seen some people that it worked really well for. My wife actually had it and it worked really well for her.

Stadol is good for people who cant have or don't want an epidural and are in good labor but wont deliver for 4 or more hours. If you give it too soon in labor it can space out contractions and if you give it too late your going to have a floppy baby and mom is going to have a harder time pushing.

We use MS and phen IM to sleep prostin/cytotec induction's or prodromers. I'm surprised to hear you use IM stuff on laboring moms it hangs out too long and I would think it would interfere with pushing and moms memory of labor but I guess I've never seen it so I can't be sure.

I think you'll like fentanyl because it can speed labor if you use it correctly. Most patients will swear too you that it doesn't work because they will still wake up for contractions. What it does do is allow them to sleep between contractions and that does provide some rest for their minds and bodies so they can push well when the time comes and not be exhausted. At first you might not like it because it wont last as long as the Demerol and phen but once you get use to it I think you'll see that it helps patients very well.

I just got back from a Michelle Murray conference and she dedicated a good portion of a day to drugs used in labor, and she has convinced me to look into fentanyl. We don't even use it in epidurals anymore. She recommends giving fentanyl after 5cms (NOT BEFORE) because it really relaxes mom and they seem to get thru the last 5cms quickly and rest in between contractions and pushing more. Her evidence states that it is NOT a conscious sedation drug, so extensive monitoring is not required....probably no more so then when using nubain, or stadol.

50mcg-100mcg q1 hour

I used to use fentanyl in my other place of employment and saw NO better results than nubain and stadol gave. And our policy required SAT monitoring while using Fentanyl. It may not be a "conscious sedation drug" but it did some strange things to folks, particularly if more than one dose was given. Of course this is all anecdotal---I just did not find it much more useful than other drugs. And as far as I know, Demerol is a no-no in L/D now, due to lowering seizure thresholds in young, childbearing-age women. I have to find some literature on that------but I know it exists. We have not used Demerol on our unit for any patients, including post-op GYNs for over 3 years now.

Did Michelle Murray have resources for her opinion on Fentanyl?

Yes, and let me get back to you on them, gotta look that up in the back of the drug section of her lecture. I have NEVER used fentanyl, not even when I worked in the ICU, so I have no experience at all with it. I would, however, like to give it a try and see if it has any better effect. It was amazing to see how many hands went in the air when asked if they used fentanyl. I just really never realized how "used" it was. I was always under the impression that it should be given only when in PACU or OR or the ICU. Murray seems to think differently. As I said, I will list her resources when I get the book out.

What I DO KNOW.......fentanyl makes me ITCHY!!!!!!!!!!!!

Lemme get the books out and get back on that.

I will be attending Dr. Murray's seminar here in Seattle in November, I will be interested in hearing this part of her lecture.

I enjoyed this one for some reason. She is a bit more feisty, if you can believe that...and since she is taking a year off, she has that devil may care attitude. I always come away with "AH HA" moments and scribbles in my book by the ton. I hope you find it as enjoying.