Pain meds and + drug use

  1. Hey all- I am sort of new to L&D and i have a queation. The other night my pt was a pt who had late prenatal care and was + for opiates in her urine at her first visit in October. She comes in to deliver, of course in pain. I get a Stadol order, which DOES NOT EVEN PHASE HER!!!! I check her and she is 4cms, so the attending says go ahead on the Epidural. The Epidural does NADA! At this point it is 7 A and I call anesthesia, give report, and go so I don't know what happens next.

    My question is this- I know if she is still on drugs the stadol will not be effective,or as effective, but does it work the same with the epidural?
    Would appreciate any answers because when we get pts like this in I am usually the one who is assigned.:spin:
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    About L&DTami

    Joined: Nov '02; Posts: 15
    Obstetric RN


  3. by   mark_LD_RN
    drug use does not usually seem to affect the epidural for pain relief.
  4. by   L&DTami
    Ok, thanks- that has been my experience, which is why I called anesthesia before I gave report that am. But all the Day nurses said -Oh it's because of her history- so I wasn't sure what to think!
  5. by   anitame
    Maybe it was a bad epidural, or maybe she was just progressing quickly. I see that sometimes, the pt will say the epidural's not helping at all, I do an SVE and she's gone from 4 to complete.
  6. by   fergus51
    It's a shame there isn't more inservices for OB nurses who look after these women. There are so many misconceptions about how drug use affects pain meds. I hate hearing "Oh it's because of her history" because that usually means "so I am not going to bother trying to help her anymore".
  7. by   mark_LD_RN
    fergus 51-- that really bothers me also. we should never prejudge someone especially when it is related to pain issues.
  8. by   fergus51
    Definitely Mark. I have heard that the biggest women's hospital in our province is openning a unit specifically for chemically dependant maternity patients. I am hoping some of their policies will filter down to us smaller hospitals soon. It is one area of OB nursing that I really feel inadequately prepared to handle, especially when most of our docs have little knowledge on the subject as well.
  9. by   L&DTami
    Originally posted by anitame
    Maybe it was a bad epidural, or maybe she was just progressing quickly. I see that sometimes, the pt will say the epidural's not helping at all, I do an SVE and she's gone from 4 to complete.
    Uh huh- I checked back and found she delivered @ 0808. I did check her to see right after the epidural bacause that has also been my experience, and she went from 4 to 6 in an hour.

    I just want to say here that I always do my best to ensure adequate pain relief no matter what my pts history may be. Which is why I called anethesia before I gave report. :wink2:
  10. by   NurseyNursey
    I didn't think that you were supposed to give Stadol/Nubain to known drug users or those on Methadone. They are not really narcotics and block the receptors causing the patient to go into withdrawl.
  11. by   mother/babyRN
    Stadol is not indicated with known drug use...That is a big deal around here. I will have to get some sleep before I can get into the explanation.. Also, with the drug people, you probably know to avoid narcan while the infant is in utero, because it will reverse the effects of the drug ( which the infant may be addicted to), and result in seizures and severe withdrawal in the newborn. Have seen that happen a couple times. NEVER want to see it again....
    Stadol is about 7 times more potent then Morphine and about 40 times more potent then demerol, so they say.....
  12. by   L&DTami
    Now I am concerned, because A) I didn't know that, and B) We give stadol to those with + hx all the time.

    I am going to look into that one for sure!
    Thanks NurseyNursey and mother/babyRN!
  13. by   mark_LD_RN
    stadol and nubain are narcotic antagonists.thats way they are not given with people with hx od drug use. it is less effective as they cancell each other out
  14. by   mother/babyRN
    Thanks Mark..I knew that but after 2 12 hour night shifts and being so tired, didn't want to get it wrong..You know how it goes when the place is wild......Hopefully, this fact is shared when people take neonatal resucitation.....It is a big deal around here and we use stadol all the time too, which is why we are so aware of it...Our chief OB makes it known to all the other OBs, who are often not aware of it....