Pharm

Active Labor Anesthesia

Active Labor Anesthesia, Labor Analgesia, Labor Anesthesia, Obstetrical Anesthesia, Pain Management in Labor

Acetaminophen
1. Dosing: 1000 mg orally every 6 hours prn
Diphenhydramine
1. Dosing: 25-50 mg orally, IV or IM every 4-6 hours
Promethazine (Phenergan)
1. Dosing: 25-50 mg orally or IM, 12.5 to 25 mg IV every 4-6 hours

Nalbuphine (Nubain)
1. Dose: 10-20 mg IV, IM or SC every 3 hours prn
2. Onset in 2-3 minutes with IV Nalbuphine and 15 minutes with IM or SQ dosing
Morphine
1. Active Labor: 2-4 mg IV every 2-4 hours (onset in minutes)
2. Latent Labor: 5-10 mg IM every 4 hours (onset in 40 minutes)
Butorphanol (Stadol)
1. IV: 1-2 mg IV every 4-6 hours prn (onset in 5-10 minutes)
2. IM: 2-4 mg every 4-6 hours prn (onset in 30-60 minutes)
Fentanyl (Sublimaze)
1. 50-100 mcg IV every hour prn (onset in minutes)
Consider Patient Controlled Analgesia
1. Fentanyl
2. Alfenta
3. Remifentanil (Ultiva)
  1. Rapid and predictable elimination with less neonatal sedation
  2. May be associated with greater Pruritus and maternal sedation than with other Opioids
  3. Background infusion: 0.05 to 0.1 mcg/kg
  4. Bolus: 0.2 to 0.5 mcg/kg
  5. Lockout: 2-3 minutes
4. Nitrous Oxide (50/50 mix with oxygen)
  1. Adverse effects include Nausea, Vomiting, Dizziness
  2. Onset is rapid with mask application, and clears rapidly with mask removal
  3. Klomp (2012) Cochrane Database Syst Rev (9): CD009351 [PubMed]