Overall Pain Management Approach

Cesarean birth

Vaginal birth

After 24 hrs: increased potency short-acting opioid (hydromorphone) with 50-70% increased dose (4-6 mg po q4-6 hrs); duration of treatment similar

First 24 hrs: anticipate increased needs, consider morphine or hydromorphone PCS; consider PCEA; consider TAP if your anesthesia department does them

Present in labor requesting something for pain.

Consider either full agonist opioid (NO nalbuphine or butorphanol) OR Offer regional analgesia (expect good response to initial placement; may need additional boluses)

Routine postpartum orders with prn opioid analgesics x24 hrs