What do you use for Post Delivery pain meds?

Jolie, BSN · Mar 21, 2005

Why did you guys quit using Duramorph? That's the modern way!! LOL

It amazes me that ANYONE in 21st century OB would still be using Duramorph.

Back in the early 90's our anesthesiologists switched to continuous epidural PCAs for C-section patients with a huge dropoff in complications and a much greater level of statisfaction on the part of patients, nurses, and OBs/CNMs.

Moms get consistently good levels of pain relief, are up and walking by the evening of surgery, have no complaints of itching, and virtually no problems with voiding once their Foleys are removed. They switch easily to po pain meds after 24 hours or so, and I don't ever remember having to give anything IM for breakthrough pain.

If anyone insisted on giving me Duramorph for a C-section, I'd get up and go to another hospital!

BETSRN · Mar 21, 2005

Some anesthesiologists (and modern ones too) do NOT use duramorph due to its potential sedating and VERY strong tendencies to interfere with bladder and bowel innervation. I work with a new anesthesiologist (who is brand new this year) who REFUSES to use duramorph due to current studies/evidence and personal experience in residency of the above problems. It just depends on individual practice.
Anecdotally, I had a duramorph spinal myself for my csection and it did not do a damn thing to control post-op pain for me. It's not always what it's cracked up to be....at least from my experience. Like anything else, it either works, or it does not. And the potential for respiratory problems is such we have to monitor them on Sat Monitors for 24 hours post-op, as well as leave catheters in that long. THAT should tell us something......that is, at least, it's not without LOTS of risks neuro and respiratory-wise, despite the benefits.
And the ITCHING is also a a HUGE inconvenience and problem........necessitating sedating treatments such as Benedryl or Nubain.
Reply:
Other than itching, we have NO problem with Duramorph at all. We might use an O2 sat monitor during the first hour of recovery (not all anesthesiologists ask for it) but that's it. We no longer monitor respirationss either.
Our patients get up anytime they want after surgery. We have patients who have a section with Duramorph in the morning and we are getting them up out of bed by evening. With a rare exception, catheters come out the same day or the next morning, as do the IV's. We don't leave anyone in bed very long, as that just ups the potential for complications as it is.
For itching, we have Benedryl or Narcan ordered. I always go for the Narcan, as we get pretty good itch relief without the sedation from the Benedryl.
I have to say, we have very low complication rates in general and most patients are using only Motrin (600-800mg) by day 2 with the option for Percocet if needed.
Isn't it funny how practices differ?

babyktchr, BSN, RN · Mar 21, 2005

Some anesthesiologists (and modern ones too) do NOT use duramorph due to its potential sedating and VERY strong tendencies to interfere with bladder and bowel innervation. I work with a new anesthesiologist (who is brand new this year) who REFUSES to use duramorph due to current studies/evidence and personal experience in residency of the above problems. It just depends on individual practice.
Anecdotally, I had a duramorph spinal myself for my csection and it did not do a damn thing to control post-op pain for me. It's not always what it's cracked up to be....at least from my experience. Like anything else, it either works, or it does not. And the potential for respiratory problems is such we have to monitor them on Sat Monitors for 24 hours post-op, as well as leave catheters in that long. THAT should tell us something......that is, at least, it's not without LOTS of risks neuro and respiratory-wise, despite the benefits.
And the ITCHING is also a a HUGE inconvenience and problem........necessitating sedating treatments such as Benedryl or Nubain.

To tell you the truth...with the PCA we get just as much itching...from the morphine or the dilaudid. What I think really makes the difference is the toradol. I have seen such a turn-around with pain control once we FINALLY got it as a standing order from the OB's. I have patients that rarely hit the old button because they are comfy. There are, of course, those whose pain is inconsolable...but I think it takes the edge off of those few too.

SmilingBluEyes · Mar 22, 2005

Ever try fentanyl in the PCA? no itching there.

babyktchr, BSN, RN · Mar 22, 2005

Ever try fentanyl in the PCA? no itching there.

No fentanyl...we don't even use it IV...our policy prevents us from using it unless on cardiac monitor. They used to use it in our epidurals...but we have gone to dilaudid.

BETSRN · Mar 22, 2005

It amazes me that ANYONE in 21st century OB would still be using Duramorph.
Back in the early 90's our anesthesiologists switched to continuous epidural PCAs for C-section patients with a huge dropoff in complications and a much greater level of statisfaction on the part of patients, nurses, and OBs/CNMs.
Moms get consistently good levels of pain relief, are up and walking by the evening of surgery, have no complaints of itching, and virtually no problems with voiding once their Foleys are removed. They switch easily to po pain meds after 24 hours or so, and I don't ever remember having to give anything IM for breakthrough pain.
If anyone insisted on giving me Duramorph for a C-section, I'd get up and go to another hospital!

Do epidural PCA's require your patients to drag a pump around with them if they are up and walking?

Jolie, BSN · Mar 22, 2005

Do epidural PCA's require your patients to drag a pump around with them if they are up and walking?

The pumps we used were small, hand-held units which could easily be placed in a pouch and pinned to a gown, much like the mini-med pumps used for terbutaline. They had lockouts, and required a "nurse" code to change the cassette, and a "physician" code to change the settings for continuous infusion or demand doses.

Anesthesia used a combination of a -caine drug (I can't remember which one) and Fentanyl during surgery and for the first 8 hours post-op. When that cassette ran out, it was changed to just the -caine drug. Hence, no itching, but good pain relief. We maintained IV access, either a running IV or a hep lock while the epidural catheter remained in place.

When we switched to this plan for C-section anesthesia, all of our RNs we required to attend a 2 day course on care of epidural PCA. After that, it just became part of our routine orientation for new employees. We had a date set for the changeover, and were all ready, but not yet using the new system when the wife of one of our OBs came in needing an unplanned C-section. She'd had a horrible past experience with Duramorph, and desperately wanted to use the PCA. It was a quiet weekend, and she agreed to be our "test case", so we went ahead with it. It worked out well, as it gave us all the opportunity to get used to the pumps and documentation in a non-hurried atmosphere. After her case, we never used duramorph again.

chrissy_leigh · Apr 15, 2005

Our hospital uses Duramorph, and people seem to have radically different responses to it. Tonight, I have one mom who was nauseous, itching, shaky and in pain right up from the OR. I have another that has taken nothing but Motrin and is be-bopping down the halls. We use 600 (Q6) or 800 Motrin (q8). Depending on the doc, vicodin or percocet. If that doesn't control it, norco, and have even seen oxycodone syrup. Ahhh, these So Cal wimpy gals... A hospital I worked at in AZ used lots of toradol, it was GREAT!

SmilingBluEyes · Apr 15, 2005

I agree, toradol makes all the difference in those who can use it!

QTBabyNurse, BSN, RN · Apr 15, 2005

On lady partsl deliveries, we use Darvocet or Motrin 800 mg(depending on the doc). C/S deliveries get PCA Morphine on 2 mg/hr continuous infusion til the next morning, then Lortab.