Duramorph question

[dilaudid]

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How long after Duramorph do you guys wait before giving Percocet? What about with Hydromorphone IT? Any differences?

 

[pgg]

How long after Duramorph do you guys wait before giving Percocet?

PRN Percocet's part of my default 24h intrathecal/epidural narcotics orders. In most cases, unless a patient is NPO, they get it soon after they get to the floor. So maybe a couple hours after the Duramorph, depending on the case.

I can't remember the last time I used IT hydromorphone.

 

[Planktonmd]

We have been using intrathecal Hydromorphone for several years in all our C Section spinals.
We switched by necessity when we could not get Duramorph or Astramorph, but when we noticed better analgesia and significantly less side effects we decided to stay with Hydromorphone.
I can't even remember the last time I was called for a patient with severe itching or nausea.
And not one case of respiratory depression since the switch
We give percocet PRN as soon as they start having pain.

 

[lgher]

plankton may I ask,

what dose of IT Hydromorphone have you been using? And how does that compare to your previous IT morphine doses?

In my institution we typically use 150 ug of morphine IT for C sections. From the brief literature search I've done, I've seen conversion of 1:3 to 1:5 IT morphine:HM. So I've been using 30-50ug of HM IT the few times I've used it.

Would appreciate your experience and impression in the matter....

 

[lgher]

and good to see you back plankton.....!