pain med...

MamaMadge, ADN, BSN · Nov 26, 2007

Fentanyl IV push, 100 mcg. q 1 hour up to a max. of 6 doses in 24 hours. We push is very slowly, like over 3-5 min. Some RN push it over 3 contractions but I think that could take too long. I agree that it doesn't work all that well if they are really active. I have noticed it causes alot of patients to vomit (oh, joy!!)....but it works well if they are in early active phase.

Elvish, BSN, DNP, RN, NP · Nov 29, 2007

When I'm in the nursery, I'd much rather get a baby of a mom who got Fentanyl than Nubain. And I've never ever seen Demerol used, EVER.

Selke · Nov 30, 2007

I push the fentanyl into the IV line with the IVF at the usual drip rate. It goes in slowly enough, IMHO. If the pt has a saline lock, I mix it with sterile NS and slow push then flush. The usual order is 50 -- 100 mcgs IVP Q 1 hour x 3 maximum. Moms usually start asking for it around 2 -- 4 cm; I know they'll eventually want an epidural when they ask this early, especially the nullips. If in transition fentanyl doesn't do squat.

I worked one hospital as a traveler where they regularly used fentanyl PCAs, with 500 mcgs of fentanyl in the pump. 25 mcgs per dose, 8 min lockout, I think, forget the maximum lockout. I'm not kidding. My eyes popped out when I saw that. Many of their pts were tiny Oaxacan women who would push, push, push those PCA buttons. I remember one nurse's pt OD'd on the stuff; her respirations dropped very low, she was unresponsive, and they gave her narcan. I had another tiny Oaxacan woman use up the ENTIRE CASSETTE. She was drugged out but the staff didn't think anything of it. She used it up before her labor was over with, then as it wore off it was like she woke up. Miraculously the baby wasn't affected -- I think it had worn off by then.

OzMW · Dec 18, 2007

Wow what an interesting thread. I've seen iv fentanyl used i labour once in 16 years. We use pethidine as opposed to morphia and I haven't even heard of some of the narcotics you guys refer to. Our units epidural rate is 20% and we use lots of nitrous oxide (gas & air as they call it in the UK). We don't push epidurals unless women are desperate to have one from the start, which are few. We usually start with the nitrous and work our way up the ladder so to speak. Unless of course a woman is not at all coping and then on the odd occasion an epidural may be suggested before anything else. We also use our showers to death, usually with the nitrous, we have extra long tubing that extends into the shower. Most of our women without any risk factors needing CEFM, would spend some of the time in the shower. Some are there the whole time and even birth there.

mommy2boysaz · Dec 19, 2007

We use mostly Nubain, some Stadol. Fairly low epidural rate~probably around 30-40%.

Rarely have any problems with neonatal depression with Nubain, and if there is any, Narcan to the baby fixes it. (Nubain isn't normally given after 7-8 cm).

allthingsbright · Dec 20, 2007

Thanks for this thread! :)

klone, MSN, RN · Dec 20, 2007

Oh, how I wish facilities in the US would use Nitrous Oxide again! I don't understand why Canada, Europe, UK, etc use it, but not us. There's some great research out there on NO's effectiveness and satisfaction of mothers afterwards.

OzMW · Dec 20, 2007

Oh, how I wish facilities in the US would use Nitrous Oxide again! I don't understand why Canada, Europe, UK, etc use it, but not us. There's some great research out there on NO's effectiveness and satisfaction of mothers afterwards.

So its not used at all?

Elvish, BSN, DNP, RN, NP · Dec 20, 2007

So its not used at all?

I've never seen it in obstetrics.

A lot of dentists use it, though.

Jill10191130 · Mar 3, 2008

We use Stadol 1mg and Phenergan 25mg IV q 4 h.

At the facility where I used to work, we gave Demerol 50 - 75 and Phenergan 25 IV q 3 - 4 hours or Stadol 1 - 2 mg q 2 - 3 hours.

I much prefer the Stadol. It seems to help with patient's pain much more than the Demerol ever thought of doing.