itching after cesarean section - page 2

Hi everyone, I have a question about I had yesterday. She had a c-section and she was complaining of pruritus all over the body. She had an epidural block for the gurgery and morphine for analgesia.... Read More

  1. by   ElvishDNP
    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.
  2. by   SmilingBluEyes
    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.
    Last edit by SmilingBluEyes on Mar 16, '07
  3. by   SmilingBluEyes
    And we are talking about Nubain used Postpartum, not in labor, in this case.
  4. by   ElvishDNP
    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.
  5. by   nursing804
    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.
  6. by   SmilingBluEyes
    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.
  7. by   SmilingBluEyes
    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.
  8. by   Dayray
    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
  9. by   SmilingBluEyes
    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.
  10. by   rnmomtobe2010
    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!!!!
  11. by   SmilingBluEyes
    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.
  12. by   NPinWCH
    I argue almost daily with my fellow nurses who complain about their patients complaining about the itching. They are quite fond of saying, "Oh come on...she's got to understand it's better to itch than to hurt." I've had 2 c/s one with duramorph and one with a PCA postop. Let me express to all of you that the itching isn't run of the mill, "Oh I have an itch." It is EXTREME and nothing makes it better. I hurt a little more with my PCA, but I was itch free and much happier.

    Benadryl made me so groggy that I was even more miserable, itchy and sleepy are not a good combo. I litterally dug my face raw. It feels like you are constantly walking thru cobwebs or your hair keeps tickling your face. At the time we didn't offer anything else for the itching, so I had to put up with it, and Duramorph itching can last up to 10 hours post dose.

    We now use Nubain almost exclusively, we've been giving it slow IVP, but I think I'm going to bring up that infusion method as it won't knock mom out so much. We also have orders for Benadryl 50mg IVP q6 h and Narcan 0.01mg IVP q5 min until itching resolved then mix 0.1mg in 100ml NS and hang at 15ml/hr. The Narcan works, BUT as it's an antagonist they end up in more pain.

    I always ask my moms to rate the itching on a scale from 1-10 just like pain...that way it's easier for them to see if they got any improvement from the intervention (though I can usually tell based on the fact that they aren't ripping their skin off!)
  13. by   babyktchr
    We use benadryl for that pesky itching, but our lactation guru says to be careful using it with breastfeeding moms. She only suggests one or two doses, because long term use can effect milk production.

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