itching after cesarean section

allnurses Guide · Mar 15, 2007

Nubain is GREAT for duramorph itching. we add about 15-20mg to a liter bag and let it run for the duration of that bag. It works great. But we also have (obviously) to look for some reversal of the beneficial effects on the duramorph's pain control. That is why I use Benedryl first. But Nubain is in the MDA orders, if Benedryl is not helpful. Can't say we ever used Demerol for itching, but we have in the past, used it for post partum shaking that is persistent and troublesome. Only needed bout 12.5 mg to do the trick. We just don't use it anymore on our unit.

We use Narcan after the Benadryl . . . . It is closely related to Nubain so I guess I'm actually not that far off from the rest of you.

I'm very careful with Narcan - that is what I spilled on my hands 5 minutes prior to my first seizure (no, I did not have narcotics in my system) - although EVERYONE and their uncle says there is no connection. I still wear gloves around Narcan though . . .

steph

Elvish, BSN, DNP, RN, NP · Mar 16, 2007

Nubain is great but it's not without its own set of issues. #1) It can knock pts into next week. 2) Sometimes it works too well & reverses the analgesic effect of the Duramorph. 3) (and this one is a little OT) If Mom gets Nubain close to delivery, baby screams like a banshee for several hours afterward. We can always tell the Nubain babes.

SmilingBluEyes · Mar 16, 2007

Nubain run in a liter of LR or NS, over hours, does not knock anyone out. That is why we do this---also its effects are great and last for a while w/o "waxing anyone's skis". A little goes a long way, used this way. Also, no sudden reversal of Duramorph occurs if its used responsibly and slowly.

SmilingBluEyes · Mar 16, 2007

And we are talking about Nubain used Postpartum, not in labor, in this case.

Elvish, BSN, DNP, RN, NP · Mar 16, 2007

Oh yeah, I got the postpartum use bit. I knew #3 was irrelevant to our conversation. Just had to throw it in as a sidenote.

We (mother/baby) are not allowed to mix meds in the IVF. Pharmacy has to. We have to give it IV push.

Interesting, though.

nursing804 · Mar 16, 2007

the itching usually subsides in about 2 hours, I was reassured and while it was still a terrible feeling, I knew that it would soon be over and it was. In the future, just make sure to reassure your patients. If you have never had it, it will drive you crazy. I had a spinal done for a cerclage insertion procedure and my legs and abdomen were itching so bad i was twiching from side to side trying to get away from the sensations, it really sucks that you are paralyzed at the same time, because I could feel the nurse in the OR trying to scratch my abd for me, but it doesn't feel like a scratch, you can only feel the fat moving from side to side, very frustrating. It's like using a rolling pin when you really need sand paper!!!!

I almost would rather have another c section and let them go on without it, it is the WORST feeling I have ever felt!

Please be empathetic towards these patients and do everything you possibly can to make them comfortable, talking helps to pass the time until the drugs wear off.

Ive practiced in postnatal and have had 4 spinals, I try to always to remember what it was like when i was on the other side of the bed.

SmilingBluEyes · Mar 16, 2007

We are allowed to add meds to IVF with a dr order (of course) and with a cosign from another RN on our unit during the mixing process.

SmilingBluEyes · Mar 16, 2007

Off topic, but we have an MDA who REFUSES to use duramorph for ANY reason. She has had some rather bad outcomes/occurences during her residency that turned her off forever to the use of it in any capacity. I have found her patients do quite well----we just start morphine PCA for them and go to percoset as soon as they are ready to take POs. They do well, just as well as duramorph folks. Personally, duramorph worked well, for 12 hours. Then it was as if someone turned off a switch in me and when it wore off I was ready to scream. Not sure if I would want it again or not, frankly. they were very reluctant to treat my pain because I had durmorph. Not a good situation.

Dayray, RN · Mar 20, 2007

Demeral is a horrible pain med , as we say "may as well spit on them". I have seen it work rarely for pain but its good for itching and shakeing after duramorph. however a problem with it is that does lower sz threshold.

Nubain works well to decrese itching but it also will decrease the effect of a ropivicain/fentanal epidural. I guess thats a bit off topic but I tend to shy away from it becuase most of our patients have CLE so I guess I dont think of it after a spinal. I've had a few docs order it for pain but as I don't have much experance with it i tend to give other stuff instead.

benadyl works too

SmilingBluEyes · Mar 20, 2007

We don't use Nubain for anything but duramorph itching where I work, Dayray. Or for labor pain----it's a choice of that or stadol for us. I find stadol is a bit better, but IV meds are not really too effective except for short-term quick pain control. Of course, have to be withdrawn later in labor, as well.

Anyhow regarding itching: If a person is itching post-fentanyl epi, she gets benedryl.

rnmomtobe2010 · Jun 22, 2007

I tell you what is odd: my son is 5 and my daughter is 16 months and they both came into this world by c-section.My scar to this day still itches like crazy all of the time. I never thought of Benedryl. Thank ya'll so much!!! I got advice and I did not have to ask!!!!

SmilingBluEyes · Jun 22, 2007

That is all fine and good, but the purpose of these threads is not to dispense or receive medical advice. Please, keep that in mind.

Thank you.