Narcotic Analgesia

Narcotic analgesics can be highly effective at treating the pain of labor. They are generally safe for the baby, although it is better to avoid large doses toward the end of labor in order to avoid respiratory depression in the newborn.

Good dosages for this purpose include:

• Dilaudid (butorphanol) 1-2 mg IM Q 3-4 hours
• Dilaudid (butorphanol) 1 mg IM and 1 mg IV every 3-4 hours
• Demerol (meperidine) 12-25 mg IV every 60-90 minutes
• Demerol (meperidine) 50-100 mg IM every 3-4 hours
• Demerol (meperidine) 50 mg plus Vistaril (hydroxyzine) 50 mg IM every 3-4 hours
• Morphine 2.5-5 mg IV every 60-90 minutes
• Morphine 7.5 - 15 mg IM every 3-4 hours

More frequent, smaller doses are better than larger, less-frequent doses. Smaller doses given IV are immediately effective, but wear off quickly. Whether that is an advantage or disadvantage depends on how close the woman is to delivery and her need for immediate pain relief.

The greatest safety with narcotics is achieved when an antagonist (naloxone or Narcan) is available to treat the baby should depression appear.