Have a question for you as an anesthesiologist.  Many of our moms are having spinals for c-sections and are given duramorph as a pain relief agent.  They then complain about severe itching and can't tolerate the baby skin to skin because it exacerbates the itching.  Then they are given something to oppose the morphine, then they are in pain.  This seems like a vicious cycle.  Any thoughts?
 

-----Original Message-----
From: Lactation Information and Discussion [mailto:[log in to unmask]] On Behalf Of Sarah Reece-Stremtan
Sent: Thursday, October 21, 2010 4:08 PM
Subject: Re: Codeine article in CMAJ

From a pain management perspective, codeine is an inferior analgesic; it just does not provide the same amount of pain relief even in equi-potent dosages as other oral medications such as oxycodone (the narcotic half of Percocet).  It actually works better in kids and is one we frequently transition to in the pre-school through school-age population.  Once we're dealing with teenagers, however, Percocet (oxycodone and acetaminophen) is a much better choice.  I would never prescribe codeine/acetaminophen (Tylenol #3) to an adult for post-surgical pain.

At my previous institution, we typically did post-op epidural infusions with bupivacaine and fentanyl, which usually worked well.  Once that was d/c'd after about 18-24 hrs, moms would get ketorolac (strong IV NSAID) or ibuprofen, along with percocets.  When they needed stronger narcotics or were not tolerating po, they could receive IV morphine.

I bet the moms who receive Dilaudid (hydromorphone) IV for post-op pain are pretty happy.... :)

Sarah Reece-Stremtan M.D. 
Pediatric anesthesiology fellow in Washington DC

             ***********************************************

Archives: http://community.lsoft.com/archives/LACTNET.html
To reach list owners: [log in to unmask]
Mail all list management commands to: [log in to unmask]
COMMANDS:
1. To temporarily stop your subscription write in the body of an email: set lactnet nomail 2. To start it again: set lactnet mail 3. To unsubscribe: unsubscribe lactnet 4. To get a comprehensive list of rules and directions: get lactnet welcome

             ***********************************************

Archives: http://community.lsoft.com/archives/LACTNET.html
To reach list owners: [log in to unmask]
Mail all list management commands to: [log in to unmask]
COMMANDS:
1. To temporarily stop your subscription write in the body of an email: set lactnet nomail
2. To start it again: set lactnet mail
3. To unsubscribe: unsubscribe lactnet
4. To get a comprehensive list of rules and directions: get lactnet welcome