post c-section pain control

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I'm interested in what other places are doing. The CRNA or anesthesiologist gives Astromorph into the epidural space. Then our epidurals are pulled immediately post-op. We have standing orders for hydrocodone 5/325 1-2 tabs and also Motrin 600 mg is an option. Sometimes anesthesia will order Celebrex for 2 days. Usually by the time recovery is over (2 hours) my patients are able to move their legs some and definitely are uncomfortable with fundal checks. What does your facility do?

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Specializes in Community, OB, Nursery.

We do spinal Duramorph which lasts for 24 hours and usually gives acceptable pain control for the first 12-18hrs, at least. Along with that, we give Toradol IV q6 x 24hrs. After that, we give 1-2 Percocet 5/325 q4 x 24 around the clock, then prn after that. Also we have prn motrin once the toradol is up. Sometimes instead of Duramorph pt will have epidural fentanyl or morphine pca but I'm seeing less of that.

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Specializes in OB L&D Mother/Baby.

It depends on who's on for anesthesia...

Some use duramorph and then we get orders for toradol q6 for 24h then go to motrin, usually after that it's prn vicodin/norco or even tylenol #3 depending on what OB orders.

For those who don't get duramorph they usually come back with a demerol or ms pca for about 24 hrs, we usually pull in the am with breakfast offer po rx... Usually the same as above toradol to motrin at 24 hrs and same pain pills

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Specializes in High Risk In Patient OB/GYN.

We try to do spinal c Duramorph for the planned Cs. (if they already have the epidural from labor, then that's what they stay with. it's pulled 3-4hrs after the section)

Then they get ONE dose of Toradol PRN on the anesthesia orders. Otherwise it's oxycodone 5-10mg, and/or Motrin 600mg and/or Tylenol 650mg.

I like having the oxycodone without the APAP because if they take a tylenol for mild soreness, then it gets worse in 30min, you don't have to worry about ODing on APAP, you can go ahead and give the good stuff. Plus they can take it q4hrs, again without worrying about APAP toxicity.

I do wish we could give more than one dose of toradol, especially for epidurals. :(

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Specializes in Family NP, OB Nursing.

Most pts get epidurals. They come back to us with continuous epidural infusions of fentanyl/-caine drugs running at 8-12ml/h. They also have PRN orders: Toradol 30mg IV q6h and Morphine 1-2mg IVP q5min up to 10mg/hr. After 24h epidural rate is usually cut in half and Motrin 800 q8h around the clock started. Epidural is then discontinued the next day and Percs 1-2 q 4-6h started. Pts who had spinal/general get morphine PCA and Toradol q6h x 24h then Percs and Motrin.

I personally think pts do better with the PCA. They move better and honestly aren't as sleepy. The pts with the epidural are really comfortable while the infusion is going but end up so unprepared for the pain when we discontinue the epidural I feel its cruel.

We have the same itching issues with the epidural infusions that we had when our previous anesthesia group used Duramorph. I'm interested to see if anyone else does infusions for 48hrs postop. Heck we even have 1 doc that likes to keep the infusion on until the morning the pts go home!!

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Specializes in L & D; Postpartum.
Most pts get epidurals. They come back to us with continuous epidural infusions of fentanyl/-caine drugs running at 8-12ml/h. They also have PRN orders: Toradol 30mg IV q6h and Morphine 1-2mg IVP q5min up to 10mg/hr. After 24h epidural rate is usually cut in half and Motrin 800 q8h around the clock started. Epidural is then discontinued the next day and Percs 1-2 q 4-6h started. Pts who had spinal/general get morphine PCA and Toradol q6h x 24h then Percs and Motrin.

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Wow! If our C/S has an epidural, it was placed while she was in labor, and is pulled in the OR because they dose them up good before the section. Scheduled C/S will have a spinal.

Most of our C/S [patients are on oral meds by 12 hours PO and are out of bed (at least at the side of the bed by 8hours. The Foley is pulled in 16 to 24 hours, they shower PO day 1 and go home PO day 2.

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Specializes in Family NP, OB Nursing.
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Wow! If our C/S has an epidural, it was placed while she was in labor, and is pulled in the OR because they dose them up good before the section. Scheduled C/S will have a spinal.

Most of our C/S [patients are on oral meds by 12 hours PO and are out of bed (at least at the side of the bed by 8hours. The Foley is pulled in 16 to 24 hours, they shower PO day 1 and go home PO day 2.

Pretty much everyone, except true crash C/S, gets an epidural. They'll try spinals if they can't get the epidural in, or it won't take.

Our pts up at side of bed in 8-12hrs and foleys pulled in 12-24hrs. Our docs try to talk EVERY C/S into staying at least 3 days, both of them prefer 4...Personally, I felt 2 was more than enough and I left as soon as I hit 48hrs and they'd let me out the door.

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Specializes in NICU, High-Risk L&D, IBCLC.

We also do duramorph spinals for all of our sections, unless pt. already has an epidural from laboring. In that case, epidural is also removed immediately post-op. In postpartum, C/S patients always get a PCA with either morphine or dilaudid and standing orders for motrin and percocet.

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See I wish we were more generous with IV pain medicine standing orders. I really like Toradol. Are there any diagnoses or reasons that it can't be given post-partum? I'm assuming patients with abnormal coags would be a case. It's very interesting to see how we all do things differently.

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Specializes in Community, OB, Nursery.

Someone with a hx of GI bleeding might not get it. Even though it is IV/IM, I have seen people get GI upset from Toradol.

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Specializes in L&D.

For the first 24hours after spinal narcotics, all analgesia is handled by anesthesia orders. Each provider is different. Most get Toradol q6h X6 doses starting in PACU, with Percocet available for break thru pain. Since epidural narcotics can cause urinary retention, their orders also include 24hr I&O, and straight cath X2prn. But most of the OB's order the cath to stay in for 24 hours if epidural narcs, so it really is moot.

Most moms dangle by 4-8 hours and are walking in 6-12hours. I feel so sorry for the rare woman who gets general anesthesia. I'm really spoiled by all the comfortable moms with spinal narcs.

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Specializes in OB.

It depends on who's on for anesthesia. We have one who will not use duramorph because of a previous bad experience with a pt.

Everyone gets PCA orders, Toradol Q6 for 8 doses, and then on to percocet.

If my pts. arent nauseous I start advancing their diet right away and as soon as they eat and hold it down, I take them off the PCA and go to percocet. It seems to work better for most people in my limited experience LOL.

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