Oxycodone as a component of multimodal analgesia for lactating mothers after Caesarean section: Relationships between maternal plasma, breast milk and neonatal plasma levels

Seaton, Suzette; Reeves, Mark; McLean, Stuart

doi:10.1111/j.1479-828x.2007.00715.x

Cited by 69 publications

(52 citation statements)

References 14 publications

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“…Relatively high amounts of oxycodone are excreted into human milk, and therapeutic concentrations have been detected in the plasma of a nursing infant. 73 Central nervous system depression was noted in 20% of infants exposed to oxycodone during breastfeeding. 74 Thus, use of oxycodone should be discouraged.…”

Section: Pain Medicationsmentioning

confidence: 99%

The Transfer of Drugs and Therapeutics Into Human Breast Milk: An Update on Selected Topics

Sachs¹

2013

Pediatrics

403

198

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Many mothers are inappropriately advised to discontinue breastfeeding or avoid taking essential medications because of fears of adverse effects on their infants. This cautious approach may be unnecessary in many cases, because only a small proportion of medications are contraindicated in breastfeeding mothers or associated with adverse effects on their infants. Information to inform physicians about the extent of excretion for a particular drug into human milk is needed but may not be available. Previous statements on this topic from the American Academy of Pediatrics provided physicians with data concerning the known excretion of specific medications into breast milk. More current and comprehensive information is now available on the Internet, as well as an application for mobile devices, at LactMed (http://toxnet.nlm.nih.gov). Therefore, with the exception of radioactive compounds requiring temporary cessation of breastfeeding, the reader will be referred to LactMed to obtain the most current data on an individual medication. This report discusses several topics of interest surrounding lactation, such as the use of psychotropic therapies, drugs to treat substance abuse, narcotics, galactagogues, and herbal products, as well as immunization of breastfeeding women. A discussion regarding the global implications of maternal medications and lactation in the developing world is beyond the scope of this report. The World Health Organization offers several programs and resources that address the importance of breastfeeding (see http://www.who.int/topics/breastfeeding/en/).

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Section: Pain Medicationsmentioning

confidence: 99%

The Transfer of Drugs and Therapeutics Into Human Breast Milk: An Update on Selected Topics

Sachs¹

2013

Pediatrics

403

198

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“…166 Because of the high concentrations of hydrocodone and oxycodone in breast milk as well as the reduced clearance of some of these medications in some neonates, mothers taking these prescription opioids should be alerted to the problem of sedation among infants when breastfeeding. [167][168][169] Breastfeeding increases mother-infant bonding, enhances maternal confidence, and encourages active maternal participation in the management of the infant. Breastfeeding may decrease the incidence of NAS, 170 the need for pharmacological treatment, 99,171 and the length of the hospital stay.…”

Section: Breastfeedingmentioning

confidence: 99%

Neonatal Abstinence Syndrome

2014

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Neonatal abstinence syndrome (NAS) is a result of the sudden discontinuation of fetal exposure to substances that were used or abused by the mother during pregnancy. Withdrawal from licit or illicit substances is becoming more common among neonates in both developed and developing countries. NAS continues to be an important clinical entity throughout much of the world. NAS leads to a constellation of signs and symptoms involving multiple systems. The pathophysiology of NAS is not completely understood. Urine or meconium confirmation may assist the diagnosis and management of NAS. The Finnegan scoring system is commonly used to assess the severity of NAS; scoring can be helpful for initiating, monitoring, and terminating treatment in neonates. Nonpharmacological care is the initial treatment option, and pharmacological treatment is required if an improvement is not observed after nonpharmacological measures or if the infant develops severe withdrawal. Morphine is the most commonly used drug in the treatment of NAS secondary to opioids. An algorithmic approach to the management of infants with NAS is suggested. Breastfeeding is not contraindicated in NAS, unless the mother is taking street drugs, is involved in polydrug abuse, or is infected with HIV. Future studies are required to assess the long-term effects of NAS on children after prenatal exposure.

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“…As a component of multimodal analgesia in the first 72 hours after Caesarean section, there may be minimal risk to breastfeeding infants as only a low volume of milk is ingested during this period (Seaton et al, 2007 Level III-3).…”

Section: Chapter 11mentioning

confidence: 99%

Acupuncture for analgesia in the emergency department: a multicentre, randomised, equivalence and non‐inferiority trial

Cohen

Smit

Andrianopoulos³

et al. 2017

Medical Journal of Australia

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Objectives: This study aimed to assess analgesia provided by acupuncture, alone or in combination with pharmacotherapy, to patients presenting to emergency departments with acute low back pain, migraine or ankle sprain. Design: A pragmatic, multicentre, randomised, assessor‐blinded, equivalence and non‐inferiority trial of analgesia, comparing acupuncture alone, acupuncture plus pharmacotherapy, and pharmacotherapy alone for alleviating pain in the emergency department. Setting, participants: Patients presenting to emergency departments in one of four tertiary hospitals in Melbourne with acute low back pain, migraine, or ankle sprain, and with a pain score on a 10‐point verbal numerical rating scale (VNRS) of at least 4. Main outcome measures: The primary outcome measure was pain at one hour (T1). Clinically relevant pain relief was defined as achieving a VNRS score below 4, and statistically relevant pain relief as a reduction in VNRS score of greater than 2 units. Results: 1964 patients were assessed between January 2010 and December 2011; 528 patients with acute low back pain (270 patients), migraine (92) or ankle sprain (166) were randomised to acupuncture alone (177 patients), acupuncture plus pharmacotherapy (178) or pharmacotherapy alone (173). Equivalence and non‐inferiority of treatment groups was found overall and for the low back pain and ankle sprain groups in both intention‐to‐treat and per protocol (PP) analyses, except in the PP equivalence testing of the ankle sprain group. 15.6% of patients had clinically relevant pain relief and 36.9% had statistically relevant pain relief at T1; there were no between‐group differences. Conclusion: The effectiveness of acupuncture in providing acute analgesia for patients with back pain and ankle sprain was comparable with that of pharmacotherapy. Acupuncture is a safe and acceptable form of analgesia, but none of the examined therapies provided optimal acute analgesia. More effective options are needed. Trial registration: Australian New Zealand Clinical Trials Registry, ACTRN12609000989246.

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Oxycodone as a component of multimodal analgesia for lactating mothers after Caesarean section: Relationships between maternal plasma, breast milk and neonatal plasma levels

Cited by 69 publications

References 14 publications

The Transfer of Drugs and Therapeutics Into Human Breast Milk: An Update on Selected Topics

The Transfer of Drugs and Therapeutics Into Human Breast Milk: An Update on Selected Topics

Neonatal Abstinence Syndrome

Acupuncture for analgesia in the emergency department: a multicentre, randomised, equivalence and non‐inferiority trial

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