Implementation of an Elective Cesarean Section Analgesia with Intrathecal Duramorph Protocol

Abstract

Use of intrathecal (IT) Duramorph, a preservative free morphine, is supported by decades of research to be the best practice for post cesarean section (c-section) analgesia. Current practice in the Labor and Delivery Unit, of a community hospital, involves epidural Fentanyl administration using a patient controlled epidural analgesia (PCEA). Optimal pain management for parturients undergoing c-sections is a complex but important issue. Ineffective pain management involve both the mother and the child with potential acute and chronic consequences (Carvalho & Butwick, 2017). Fentanyl PCEAs have multiple disadvantages including risks associated with an epidural catheter being in place for multiple days. Disadvantages of an epidural catheter include decreased patient mobility, increased opioid administration, increased infection rates, increased epidural hematoma rates, high failure rates- including catheter occlusions, displacement, leaks, and uneven blocks, and increased costs (Rawal, 2021). The benefits of changing from PCEA to IT Duramorph involve reducing these risk factors. Additionally, IT Duramorph administration is a better alternative because of reduced incidence of postdural puncture headaches, reduced opioid administration, and reduction in postoperative pain, benefiting both mother and baby (Carvalho & Butwick, 2017). Developing and implementing a protocol for IT Duramorph will benefit all parturients undergoing elective c-sections. Many factors contribute to the current lack of best practice continuing to be carried out at this facility and include current policies and procedures, reluctance from staff and leadership, as well as a lack of education and by-in to support the practice change. The root cause of this problem of not providing the best evidence-based care is shown by the fishbone diagram in Figure 1.