Pain medications post partum

serenity1 · Nov 20, 2011

In my hospital, most lady partsl deliveries receive a bag with benzocaine spray, acetaminophen, ibuprofen, and a stool softener that the patient can take as needed. They may also have an order for 1 percocet q4 hours if they have tears or lacerations. For c-sections, they usually have orders for iv morphine q1 hour,and toradol 30 mg q6 hours for 24 hours only. After that, they receive 2 percocet q4 and ibuprofen 600 q6 for pain management. This usually is adequate for our patients. Once in a while, the c-sections may have Lortab or Vicodin instead of percocet. Hope this helps.

CoppertopRNC, BSN · Nov 20, 2011

Thank you for your prompt reply. We have generally ordered ibuprofen 600 mgm q4 prn and Tylenol#3 1-2 tabs prn along with dibucaine ointment, dermoplast spray, dulcolx suppository, percolace and ice pads prn for lady partsl deliveries. For c-sections we use Tylenol #3 1-2 tabs q3-4 hours prn and Ibuprophen 600mgm po q4 x24 hours along with ivp or IM( depending on the provider) morphine or Demerol. We also provide them with stool softener options, tucs for hemorrhoid relief and generally some anti nausea med. I think our mess our probably sufficient, I am believing it is more our staffs reluctance to provide these mess that is, unfortunately, the issue! As we begin to address the problem, I want to make sure I cover all our bases though:)

allnurses Guide · Nov 20, 2011

I usually give my C-section patients duramorph in their epidural/spinal. Then I also do a TAP block right after closure in the OR to reduce incisional pain. http://www.anesthesia-analgesia.org/content/106/1/186.full I order percocet 1-2 tabs q4hr post op. The Obstetricians start Toradol Q8h. Morphine prn is used for severe pain. The TAP block, duramorph, and Toradol is the only thing the majority of C-section patients need.

LouisVRN, RN · Nov 20, 2011

After my delivery I was given motrin 400 q 4 prn, stool softener and the dermoplast spray, really only used the last too. I think I took two doses of motrin to help with the swelling.

Double-Helix, BSN, RN · Nov 20, 2011

OP, do you know why your facility doesn't use po narcotics for post partum pain? Percocet 1-2 tabs q 4 has been offered anywhere I have been. I understand that percocet can transfer into the breastmilk, where as Tylenol with codeine is a much lower dose (and strength) narcotic so less tranferable in breastmilk.

But C-sections are major abdominal surgeries. Patients can refuse the narcotics in favor of something else weaker, but a stronger medication should be available. We give Tylenol #3 to out post op tonsillectomies. I can't image giving it as the only medication for a major surgery. If I had to guess, I'd say that's why your patients are complaining about pain control.

**LibraSunCNM, BSN, MSN, CNM** · Nov 20, 2011

Our lady partsl deliveries generally have PRN orders for 1-2 Percocet q4h and Motrin 600 mg q6h. Most just take Motrin, unless they have bad lacerations. We also provide ice packs, Dermoplast spray, Tucks pads, and Dibucaine ointment as topical relief.

Our c-section moms keep their epidurals in until post-op day 2, which I think is grossly excessive, with additional PRN Toradol q6h. Once they're day 2 the epidural comes out and we switch them to PRN Percocet, Motrin, and Ultram (usually either Percocet OR Ultram, with the Motrin, whichever works best for the patient).

allnurses Guide · Nov 20, 2011

Our lady partsl deliveries generally have PRN orders for 1-2 Percocet q4h and Motrin 600 mg q6h. Most just take Motrin, unless they have bad lacerations. We also provide ice packs, Dermoplast spray, Tucks pads, and Dibucaine ointment as topical relief.
Our c-section moms keep their epidurals in until post-op day 2, which I think is grossly excessive, with additional PRN Toradol q6h. Once they're day 2 the epidural comes out and we switch them to PRN Percocet, Motrin, and Ultram (usually either Percocet OR Ultram, with the Motrin, whichever works best for the patient).

I haven't heard of keeping the epidural in for another day post c-section. What about pp bleeding, uterine atony, risk of PE/DVT, pneumonia etc. IMO there are many more benefits for the patient to be up walking right away then leaving epidural in for another day.

Elvish, BSN, DNP, RN, NP · Nov 20, 2011

Vag deliveries:

Motrin 600mg q6 prn, and either Percocet or Norco 5/325 1-2 q4 prn. We give topical dermoplast spray and witch hazel pads. We find the witch hazel pads work really well for laceration pain when you put them on top of the peripad.

C/sections:

Usually is Duramorph x 24 hours, along with IV Toradol 30mg q6 around the clock x 24h. We can give 1-2 Norco prn for breakthrough pain while the Duramorph is in effect. If the pt is still not tolerating PO well, we can give 1-2mg morphine IV q2h. After the 24h of Duramorph, we do 24h of scheduled Percocet - 1-2 tabs q4, after which it goes to prn. At that point (after 24h Duramorph) we go to Motrin 600 q6 as well.

You get your occasional patient with either a drug hx or a poor response to pain meds that makes it hard to control their pain but for most people this is more than enough. I have to say, I like how we're given lots of tools for pain control.

allnurses Guide · Nov 20, 2011

Vag deliveries:
Motrin 600mg q6 prn, and either Percocet or Norco 5/325 1-2 q4 prn. We give topical dermoplast spray and witch hazel pads. We find the witch hazel pads work really well for laceration pain when you put them on top of the peripad.
C/sections:
Usually is Duramorph x 24 hours, along with IV Toradol 30mg q6 around the clock x 24h. We can give 1-2 Norco prn for breakthrough pain while the Duramorph is in effect. If the pt is still not tolerating PO well, we can give 1-2mg morphine IV q2h. After the 24h of Duramorph, we do 24h of scheduled Percocet - 1-2 tabs q4, after which it goes to prn. At that point (after 24h Duramorph) we go to Motrin 600 q6 as well.
You get your occasional patient with either a drug hx or a poor response to pain meds that makes it hard to control their pain but for most people this is more than enough. I have to say, I like how we're given lots of tools for pain control.

You should ask your anesthesia providers about doing TAP blocks for C-sections. Our Obstetricians and PP nurses love them.

Elvish, BSN, DNP, RN, NP · Nov 20, 2011

I haven't heard of keeping the epidural in for another day post c-section. What about pp bleeding, uterine atony, risk of PE/DVT, pneumonia etc. IMO there are many more benefits for the patient to be up walking right away then leaving epidural in for another day.

I have seen pts come to me with PCA epidural Fentanyl, no bupivicaine (our standard numbing agent) so they can get up and walk around and do pretty well. That said, I am surprised anyone can keep an epidural in for 2 days like that. I don't know if it's just me or if it's our anesthesia dept. or what, but if my pt is moving around well and sitting up and rolling side to side, her epidural tends to migrate out of place within about 12 hours. I am only too glad to pull it and start PO meds anyway.

**LibraSunCNM, BSN, MSN, CNM** · Nov 20, 2011

I haven't heard of keeping the epidural in for another day post c-section. What about pp bleeding, uterine atony, risk of PE/DVT, pneumonia etc. IMO there are many more benefits for the patient to be up walking right away then leaving epidural in for another day.

I totally agree. However, we do get them up out of bed post-op day one. The mix of meds in the epidural post-op is such that they can be up and moving around with full sensation. But the moms who get the epi out earlier seem to do just as well on the oral meds as the moms do a day later.

I haven't heard of any other hospitals where the epidural stays in post-op, much less for 2 days, but we have a very, ahem, controversial MD running our anesthesia program and I personally suspect it's all about lining the coffers charging the patients' insurance for as many bags of epi medicine they can (I'm told each bag costs about $150, and each patient goes through at least 3 in their post-op course). But that's just my opinion.