questions about duramorph and c-sections

offlabel · Mar 17, 2017

It's preservative free and is added to the local anesthetic for the spinal block. So for example, I use 1.6 mls of .75 % Marcaine (7.5 mg/ml) and add .25 to .3 mg of morphine to that. I inject the whole solution together for the block before the C section. It modulates pain signals directly at the spinal cord for almost a day, and continues well after the Marcaine has worn off (about 2 hours). Only a very small dose is needed because of where it is placed. It has no real role in the anesthesia for the C section, just post op analgesia.

nomadcrna, DNP, CRNA, NP · Mar 26, 2017

Just a note. Current literature recommends smaller dose of duramorph. In the .15mg range. Same pain relief but much less side effects.

I've switched to doing TAP blocks. Pain relief is comparable but again, less side effects and no need to worry about resp. depression.

allnurses Guide · Mar 26, 2017

I often do neuraxial morphine and TAP blocks for c-sections. The initial literature 2009 and before showed no additional benefit (due to flawed methods and statical corrections), but since that time there has been other articles that show benefits of providing both as part of a multi-modal analgesia regimen.

Transversus abdominis plane block provides postoperative analgesic effects after cesarean section: additional analgesia to epidural morphine alone. - PubMed - NCBI

Ultrasound-guided bilateral transversus abdominis plane blocks in conjunction with intrathecal morphine for postcesarean analgesia. - PubMed - NCBI

offlabel · Mar 27, 2017

I'm lucky if I can make out .25 ml of morphine let alone .15 ml. I'd go more blind than I already am. I'm not going to spit hairs over a tenth of a mg. Itching isn't the end of the world, either.