Pain medications post partum

[CoppertopRNC]

We are researching what pain medication modalities are used for post partum pain control across the country. Currently, for lady partsl deliveries what does your facility use? And for c-sections, what is your most common routine? It seems recently that our patients are complaining of inadequate pain control so we want to see if we might be able to consider a better plan. Thanks so much for any input you might have!

[melmarie23, MSN, RN]

its prn and most dont use it. I give them the option of 1-2 tabs if they are needing something stronger. I give them that with the tylenol and usually that is enough to tie them over til their next dose of motrin. I dont think I've ever given the oxy to a vag delivery patient q3....its more in between doses of their q6 motrin if anything...so its more like q6 if they get it.

Section patients do get duramorph in their spinals. If our vag patients go back for a section and had an epidural, that gets pulled and a spinal placed. Rarely do we have a section patient on a PCA. It does happen, but not very often.

[rn/writer, RN]

its prn and most dont use it. I give them the option of 1-2 tabs if they are needing something stronger. I give them that with the tylenol and usually that is enough to tie them over til their next dose of motrin. I dont think I've ever given the oxy to a vag delivery patient q3....its more in between doses of their q6 motrin if anything...so its more like q6 if they get it.

Section patients do get duramorph in their spinals. If our vag patients go back for a section and had an epidural, that gets pulled and a spinal placed. Rarely do we have a section patient on a PCA. It does happen, but not very often.

Both parts of your message are reassuring. I guess I was just floored at even the possibility of 10 mg oxy q 3. We have vag moms that want Percocets initially. Usually, they are the ones with 3rd or 4th degree lacs or a groin pull from pushing or some other type of discomfort that goes beyond the normal cramping and epis. pain.

And I'm glad to hear that the section patients are on Duramorph and not just expected to get by on 15 mg Toradol. I'm happy to see Duramorph being used more and more often on our unit. Not having to lug the PCA stand around (along with the Foley bag) helps them get mobile more quickly. I also like the even rate of coverage. It has never made sense to me that our PCA patients almost never have a basal dose to cover sleep times, and then they wake up in severe pain. Duramorph is a great improvement over that.

The most common downfall with the Duramorph is the itching, but our order sets include Benadryl, Nubain, and Narcan and we've had good results with those options.

Thanks for explaining.

[melmarie23, MSN, RN]

We also have orders for Nubain too. It does work well for the itching.

and of course we have the requisite orders for anti-nausea meds for our section patients (and for our patients with epidurals).

No problem with being asked to explain. I'll try to be more clear next time. :-)