Postcesarean Analgesia with Both Epidural Morphine and Intravenous Patient-Controlled Analgesia

Wittels, Bernard; Glosten, Beth; Faure, Eveline A. M.; Moawad, Atef H.; Ismail, Mahmoud; Hibbard, Judith U.; Senal, Jonathon A.; Cox, Suzanne M.; Blackman, Samuel C.; Karl, Leah; Thisted, Ronald A.

doi:10.1213/00000539-199709000-00021

Cited by 72 publications

(23 citation statements)

References 20 publications

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“…This elevation may lead to better milk production, which may partly compensate for harmful outcomes. In line with this observation, in one study, post-cesarean analgesia with epidural morphine had a relatively positive effect on offspring, who were more alert and oriented to animate human cues (Wittels et al, 1997).…”

Section: Human Datamentioning

confidence: 73%

Behavioral effects of perinatal opioid exposure

2014

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Section: Human Datamentioning

confidence: 73%

Behavioral effects of perinatal opioid exposure

2014

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“…Breastfed infants whose mothers received pethidine (meperidine) were less alert and oriented to auditory cues after Caesarean section than those of mothers receiving morphine (Wittels et al, 1997 Level II). As norpethidine (normeperidine) accumulates in breast milk with repeated use and has very slow neonatal elimination, pethidine use during breastfeeding is not recommended (Ito, 2000).…”

Section: Opioids and Tramadolmentioning

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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“…A prospective study examined 102 full-term births by cesarean section (Wittels et al, 1997). The patients were given EA with 2% lidocaine and 1:200,000 epinepherine to facilitate birth.…”

Section: Use Of Anesthetic Agents To Control Pain Following Birthmentioning

confidence: 99%

Breastfeeding Problems Following Anesthetic Administration

Howie

McMullen²

2006

jpe

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Research literature supports the notion that maternal comfort should be considered a priority and that mothers should receive adequate information regarding any drug prior to receiving that drug. Some studies indicate that difficulties with breastfeeding may be related to the amount of the anesthetic or analgesic that is administered to the mother. Thus, it seems wise to administer the lowest possible dose to the mother in order to minimize the amount of drug (or metabolite) exposure to the nursing infant. Infant exposure can be further reduced if breastfeeding is avoided during the times when the mother receives high doses of anesthetics and analgesics. However, because relatively small amounts of the drug are excreted into the breast milk, some mothers may opt to continue nursing after weighing the benefits of breastfeeding against the potential risk to the infant. Others may choose to ''pump and dump'' breast milk while they receive anesthetic or analgesic agents. Any concerns in this regard should be discussed with the anesthesia provider, preferably prior to labor or to any surgeries while breastfeeding.

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Postcesarean Analgesia with Both Epidural Morphine and Intravenous Patient-Controlled Analgesia

Cited by 72 publications

References 20 publications

Behavioral effects of perinatal opioid exposure

Behavioral effects of perinatal opioid exposure

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

Breastfeeding Problems Following Anesthetic Administration

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