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?

We do the Duramorph then pull the epidural/spinal after delivery and they can have perc, motrin, or tylenol prn. the pts. really itch like crazy with the duramorph and some of them vomit a lot. anesthesia orders also have meds for these side effects. the pts who had general anesthesia for c/s get PCA's, usually dilaudid. i have never seen the pca provide much pain control at all. it just seems to make them very dizzy. when it gets to be about 18-24 hrs post op i usually call anesthesia and get the pca d/c'd for po perc and motrin. once they start taking the po meds they all say they feel 100% better and actually want to get up and walk in the hall and actually hold their baby!

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Specializes in Obstetrics.

I am impressed with the pain management going on here. It is one thing I am fighting to change in my current locale.

Most of our C/S request general...and they get it. If they do have an epidural in labor of course it is used (if it still works).

Post delivery, we use Morphine PCA for up to 24 hrs. There all also orders for Voltaran PR, Tylenol #3 Q4-6hrs prn and regular Tylenol Q4-6hrs.

On top of this...the nurses are AFRAID to use narcotics! Quite a challenge.

Melissa

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Specializes in many.

What a range of responses!

We use spinals for scheduled c/s but if the mom has hypotension issues, then it is an epidural and they sloooowwwwwlllllyy dose it up for anesthesia.

General is used very rarely as we are a teaching hospital and those residents need to take their time getting to a baby. Plus we really believe that general is more dangerous for Mom and baby. Especially in this neck of the woods where a 300 lb mom is a normal day and we don't get fussed until the pt is greater than 500 lb.

Labor pt's will keep their epidurals and get dosed up but will have the catheter removed before they leave the OR.

We get a PCA for everyone either MSO4 or Dilaudid.

Toradol is ordered intra op following delivery then q 6 x 3 doses. A few of our MD's will not allow Toradol d/t issues with breastfeeding. I guess there was ONE study ONE TIME that contraindicated it.

Anesthesia is responsible for narcotics until the PACU time period is complete then we revert to OB orders.

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We do Fentanyl/Ropivicaine PCEA x 12-16 hrs post c-section. For breakthrough pain, pt can get Morphine 2-4 mg, Toradol 15 mg, or Motrin 200 mg depending on what anesthesia orders. Once we pull the epidural out, then the pt starts on 1-2 Percocets every 4 hours PRN, or Mepergan Fortis every 6 hrs, with Toradol every 6 hrs PRN if the MD orders it. Some pts get Morphine or Dilaudid PCAs if their babies are in ICN so they have sensation back in their legs to visit them.

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Yea, just as I suspected. Our pain control stinks. Like I stated before, Astromorph in OR then Norco or Motrin. I had a lady with general last night. She had a morphine PCA however after 13mg, she was still in considerable amount of pain. We then switched her to Dilaudid PCA. Her pain was a 2 when I discharged her from recovery. I suggested Toradol and the residents were not having it. It's embarrassing, we are a very large teaching hospital and very skimpy on pain med it seems.

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

Try to be a patient advocate. I have been known to call MDs for additional meds for breakthrough pain when percoset and toradol are not enough. I have had them give me authorization to administer oxycodone, 5 or 10 mg for breakthrough pain and even ativan for some patients for whom nearly intractible pain was clearly linked to anxiety on their parts.

The bottom line is: Patients have every right to adequate and reliable pain control post-op, end of story. Keep bugging them until changes are made. Elevate your concerns if need be. There is no excuse for lousy pain control after surgery and it impedes proper healing. I have 2 close friends so traumatized by inadequate pain control that they refused to have any more children after their first (and only) csections. I myself had poor pain control after my own. I have learned a lot from these experiences. Pain control is a very important issue in post operative healing.

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Specializes in L&D,Wound Care, SNC.

We also use Duramorph here unless pt has HSV (this also depends on who is covering) since it can cause exacerbation. Our pain meds ordered also depends on who the anesthesiologist is who is covering.

In PACU all but one 'ologist is very generous with the pain meds. The intrathecal orders are valid from 12-24 hours (depends on who wrote them).

In PACU (we have our own c/s recovery area so we are the recovery nurse) we can give in numbered order to keep pain

1. Fentanyl 25-50 mcg IVP q 5 min max of anywhere from 100-250 mcg

2. Morphine 1-4 mg IVP q 5 min max of anywhere from 20-30 mg

3. Dilaudid 0.4-0.5 mg max of 2-4 mg

Toradol 15-30 mg IVp x1. (Not all Anesthesiologists allow Toradol)

Once out of PACU then they can have 1-2 Percocet po q4h prn

or Morpine 1-2 mg ivp may repeat x1 in 10 min, then q1h prn

sometimes Toradol 30 mg ivp q6h prn max of 3 doses. Also, if medication does not provide adequate pain control then a PCA may be started per the OB's orders. It can be started in PACU without contacting anesthesia.

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