II. Preparations: Non-Opioids
-
Acetaminophen
- Dosing: 1000 mg orally every 6 hours prn
-
Diphenhydramine
- Dosing: 25-50 mg orally, IV or IM every 4-6 hours
-
Promethazine (Phenergan)
- Dosing: 25-50 mg orally or IM, 12.5 to 25 mg IV every 4-6 hours
III. Preparations: Systemic Opioids (30 minutes to 2 hours relief)
- Nalbuphine (Nubain)
- Dose: 10-20 mg IV, IM or SC every 3 hours prn
- Onset in 2-3 minutes with IV Nalbuphine and 15 minutes with IM or SQ dosing
-
Morphine
- Active Labor: 2-4 mg IV every 2-4 hours (onset in minutes)
- Latent Labor: 5-10 mg IM every 4 hours (onset in 40 minutes)
- Butorphanol (Stadol)
- IV: 1-2 mg IV every 4-6 hours prn (onset in 5-10 minutes)
- IM: 2-4 mg every 4-6 hours prn (onset in 30-60 minutes)
-
Fentanyl (Sublimaze)
- 50-100 mcg IV every hour prn (onset in minutes)
- Consider Patient Controlled Analgesia
- Fentanyl
- Alfenta
- Remifentanil (Ultiva)
- Nitrous Oxide (50/50 mix with oxygen)
- Adverse effects include Nausea, Vomiting, Dizziness
- Onset is rapid with mask application, and clears rapidly with mask removal
- Klomp (2012) Cochrane Database Syst Rev (9): CD009351 [PubMed]
IV. Preparations: Spinal Anesthesia or Neuraxial Anesthesia (3-6 hours relief)
- Indications
- Cervix dilated to 4 cm or beyond
- Options