Pain medication in Postpartum

  1. [font="palatino linotype"]i have done some research on types of pain medication that work best for different types of pain, but i am unable to find anything extensive.

    i am aware of cramping being treated best with ibuprofen/naproxen, but what about incision pain or perineum pain or hemorrhoid pain. how do you use norco differently than toradol, etc.?

    websites or insight would be greatly appreciated.
  2. Visit LuvofNursing profile page

    About LuvofNursing, MSN, RN, NP

    Joined: Nov '07; Posts: 145; Likes: 247
    FNP-BC.... almost!; from US
    Specialty: 7 year(s) of experience in Obstetrics, M/S, Family medicine


  3. by   nicolel1182
    only from personal experience, for hemrroids I was given witch hazel pads just in case

    for tearing down below I used lidocaine spray
  4. by   Hopefull nurse

    From personal experience, I have to say that those tiny pills by the name of Percocet (I am not sure about the spelling), worked like heaven for me. I had 2 C-sections and for my first child, I didn't take the pills when offered b/c I was laying in bed and in no pain. It wasn't until I got up for the first time that I thought I was going to die! I had to hold on to my nurse in order to make it to the bathroom.
    For my second child, I took the pills EVERYTIME and when I got up for the first time after the C-section, I did so with no help. I was able to use the bathroom w/o any pain, and I was walking up and down the hospital floor w/ very little discomfort. It was like soreness after excersing....nothing to cry about.

    I loved those pills.
  5. by   jennylouwho
    Also chiming in with personal experience...

    Witch hazel and the spray work out quite nicely.

    I had a c/s with my first and took something, maybe Percocet but I quit taking it less than a week PP and the only reason I needed it beyond the first few days was b/c I ended up with a UTI.
  6. by   woopcrane
    I Start with the non-medicstions: - ICE packs, Peribottle baths and sitz baths, Closely followed by witchhazel, proctofom, followed by Motrin for the uterine cramping, Tylenolfor inflamation, and getting OUT OF BED!!

    For 3rd - 4th degree lac I may prescribe 1 percocet and colace.

  7. by   woopcrane
    Vagina. She didnt realize what it ment...
  8. by   sahm02
    toradol is usually given the first 24hr postop, first dose in the OR then every 6hrs after that for pain, then when the pt can start taking in PO changed to Norco. or for a vaginal delivery, norco or motrin, depending on their pain once the pt is eating, ice packs, tucks pads, colace etc.
  9. by   beachmom
    At our hospital postpartum:

    Toradol is closely related to ibuprofen. Usually after C/S it's IV Toradol for 24 hours then ibuprofen for inflammation and cramping pain. Vaginal birth moms don't get Toradol. Of course, ice and witchhazel prn. Tylenol is ordered for mild pain or fever.

    Norco is the same stuff as Vicodin (hydrocodone and Tylenol). Percocet works better (oxycodone and Tylenol) but I have heard it's easier to get addicted or something. Norco is usually ordered, Percocet occasionally ordered. These are good for incisional pain or pain not relieved by ibuprofen. Vaginal birth moms usually get lower dosages, and they usually need them only occasionally. C/S moms get a higher dose and often need them every four hours.

    In pts with a lot of pain, we encourage them to take the Norco and the ibuprofen together as they get the pain from different directions and knock it out better. Most C/S pts have IV morphine for breakthrough pain ordered. Rarely this is needed.

    Sometimes C/S pts get PCA morphine (or rarely dilaudid) for the first day. Occasionally a C/S keeps their epidural after surgery for a few hours. We hate them because they don't help the pain very well, and the pt. can't get up and around. We usually convince the pt. to "refuse" the epidural, and then we can pull it and get started on the PO medicine which works better.

    We have a couple anesthesiologists who do a "tap block" on C/S pts. That's a local anesthesia put in the incision. It lasts about a day, and it works wonders. pts are out of bed much sooner and don't need much narcotics until the next day when it wears off.

    Hope this helps.
  10. by   paacollins
    I've had two c-sections. IV Morphine was first, followed by ibuprofen and Tylox with the first baby, ibuprofen and Vicodin with the second. I found the ibuprofen to be a Godsend when it came to helping the pain of uterine cramping.

    I agree with that "felt fine lying down but when I got up I felt like I was gonna die stuff". The first baby was a breeze. With the second I had a lot of scar tissue, some of which was attached to my bladder. I thought I'd hop right on out of bed like I did with my first baby. Um, nope. I felt like I got up but my organs stayed in the bed. Happily by post-op day #2, I was much better.

    I have never used Toradol but heard good things about it. It must not have been used much when I had my kids.
  11. by   madwife2002
    Quote from woopcrane
    I Start with the non-medicstions: - ICE packs, Peribottle baths and sitz baths, Closely followed by witchhazel, proctofom, followed by Motrin for the uterine cramping, Tylenolfor inflamation, and getting OUT OF BED!!

    For 3rd - 4th degree lac I may prescribe 1 percocet and colace.


    1 percocet? for 3rd-4th degree tears I think midwives are stricter here in the US than UK. My babies were a long time ago and i cant really remember but I am sure I got 2 X percocet for breast pain when my milk came in I cannot imagine what I would have needed for a large tear.
  12. by   proudnurseRN
    Can only speak from personal experience. Vaginal birth with a tear/3rd degree episotomy. Some cramping issue but most painful was the fire down below. Found the spray and witch hazel to be products from heaven. Medication wise when I asked for some ibuprofen, the nurse said "You can have something stronger if you need it..." to which I said, no just ibuprofen.

    I couldn't see downstairs, but I had a student nurse and her clinical instructor come in PP day 1 and I can tell I wasn't looking pretty down there. Cut, bruised, with some hemorrhoids to boost. Really though it was probably less painful that it looked.
  13. by   Kylea
    Personal experience: 4th degree tear/cut with a major case of hemmorhoids....I can't take vicodin, percocet, or codeine, so I got two doses of IM Toradol and tylenol/motrin alternating after that. I also used the lidocaine spray and witchhazel pads. After the spinal headache was treated w/a blood patch, I only needed occasional motrin at home.
  14. by   cherokeesummer
    Wow compared to some of the responses here our unit provides a lot more meds, sometimes I wonder if that is the problem with our patients not wanting to get up.

    CS come over with epidural in place and keep it 1-2 days there have been rare ppl who had it on day 3. I encourage removal as soon as they can tolerate it b/c I really don't see how it helps them a lot, some ppl yes but most of them seem to be ready to be done with it sooner rather than later. CS also have toradol q 6 for about 2 days. They can have percocet in between for breakthrough pain. Vaginal deliveries can have motrin 800 or percocet or both. I try to start out slow, if my patient is complaining of cramping (vaginal) I try a motrin and then if that doesn't help or if they ask for somethign stronger I will try one percocet (we are allowed to do 1 or 2 q 4 hours prn). But I strongly encourage ambulation, especially for cs patients, they really need to get that gas out.

    Personal experience, having had a cs as well as a few other surgeries, pca pain management is not good for me, I do better with po meds. I think toradol is good iv though for many pains and I think if I have another child and its a cs delivery I will try to find an alternate route, or have the epi pulled asap. I just don't find the benefit in it and always did better with other methods of pain management. And walking as soon as I could was always helpful!

    I am just shocked sometimes at how much time post partum patients spend in bed, I think it really helps to be moving and doing things even if its just within one's room.