POST OP NAUSEA -which drug do you like?

[Fairlythere]

I work on a med-surg floor and we mostly do gynecological surgeries, though we have others too. It seems most people coming back have nausea/vomiting within a couple hours. Most of our post op standing orders call for Phenergren IV, PO, or PR , Onadestron or Reglan. Reglan is useless if they are not eating. Zofran has little effect it seems and Phenergren zonks them out so bad I HATE giving it. They are already drowsy, on PCA's of some sort and had spinals.

What do you all do? What can we suggest to the MD's? Vistaril is seldom if ever used. One older RN told me once of some drug they gave that worked wonders and was very inexpensive, but I can't think of it. (maybe droperidol? or Tigan? ) She did not know why they don't give it anymore, but said they still have it in the pharmacy. I have never used either of them.

When I had surgery the anesthesists always gave me something and I never had post op nausea.

So, whats your opinion?

[rnsjbrn]

12.5 mg of Dilaudid? I think that nurse means 12.5 of Demerol. Giving 12.5 of Dilaudid would be fatal. Please don't anyone give that to a patient.

[canesdukegirl, BSN, RN]

If you are seeing a new rash of post op patients with n/v and you work in a university hospital, remember that the new residents are just starting. I have just gotten a rash of patients that have gone into RVR and Vtach because the anesthesia residents are new and don't know the ropes yet (YIKES!).

Phenergan is horrid because you can't reverse it. There is nothing that you can do if you are taking care of these pts post-op because the BEST way to manage post-op n/v is prophylaxis. I have seen Zofran work for the most part. The scolpolomine patches work well, but is best used pre-op. If you have uncontrolled n/v in the PACU, I have seen some anesthesiologists use Prop, although I think that is pretty rare.

[canesdukegirl, BSN, RN]

12.5 mg of Dilaudid? I think that nurse means 12.5 of Demerol. Giving 12.5 of Dilaudid would be fatal. Please don't anyone give that to a patient.

She may even mean 12.5 of Phenergan. I would give Demerol if the pt had pretty serious post-op shakes. I would never give 12.5 of Dilaudid! GOD! Have the crash cart ready!

[LouisVRN, RN]

I have found that 8mg IV Zofran given IVPB works reasonably well as long as the pt isn't TOO nauseas (Dry-heaving already) at the point where they are dry heaving, or sitting with an emesis basin in their laps I'll usually request 12.5 Phenergan IVPB then repeat x1 if no relief. I really dislike giving Compazine. The first patient I gave it to developed tardive dyskenesia after one dose and its really made me cautious about ever giving it.

[K+MgSO4, BSN]

Pethadine for N&V?? I just looked up demerol on the net as it is a brand name that I am not familiar with. Pethadine is an opiate analgesia that I may use for post op shakes but not for N&V.

However I have given 12.5 of Prochlorperazine (Stemetil) IM. As it is not recommended to be given IV. Ondansatron works good on some people, metoclpramide for others.

Cyclizine is good but with its ability to potentate opiates/opioids it is carefully controlled in the post op setting as most of my patients are on at least one narcotic, so curing their N&V is great but narcing them not such a good side effect!