ABM Clinical Protocol #15: Analgesia and Anesthesia for the Breastfeeding Mother, Revised 2017

Reece-Stremtan, Sarah; Campos, Matilde; Kokajko, Lauren

doi:10.1089/bfm.2017.29054.srt

Cited by 34 publications

(32 citation statements)

References 42 publications

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“…However, limiting maternal codeine use to 2 to 3 days, rather than the nearly 2 weeks as described in the case, may have prevented accumulation in the infant and thus averted this unfortunate outcome . Nevertheless, codeine use is discouraged because of its relatively high rates of sedation in infants and unpredictable metabolism . Hydrocodone is also best avoided because of its lower clearance rate in neonates .…”

Section: Selected Agentsmentioning

confidence: 97%

“…The preferred choice of analgesic for mild to moderate pain in a woman who is breastfeeding is a nonsteroidal anti‐inflammatory drug (NSAID) or acetaminophen (Tylenol) . The preferred NSAID is ibuprofen (Advil) because of its short half‐life and poor transfer to breast milk . Low‐dose (<162 mg/day) acetylsalicylic acid (aspirin) may also be considered .…”

Section: Selected Agentsmentioning

confidence: 99%

“…Morphine (MS Contin) is one of the safer opiate choices during breastfeeding because of its poor oral bioavailability and limited transport into breast milk . It is a milder opiate with a comparatively large body of data documenting its use during breastfeeding, with few cases of infant sedation and no cases of infant death associated with its use to date .…”

Section: Selected Agentsmentioning

confidence: 99%

“…Although morphine has a low RID, it has active metabolites with unknown effects in the infant and warrants continuous monitoring for sedation, as with all opiates . Hydromorphone (Dilaudid) is also considered acceptable because of its low RID and lack of active metabolites; however, it is a stronger opiate with fewer data about its use during breastfeeding …”

Section: Selected Agentsmentioning

confidence: 99%

“…Hydrocodone is also best avoided because of its lower clearance rate in neonates . Oxycodone should not be prescribed as it can reach relatively high concentrations in breast milk and has an increased frequency of infant sedation …”

Section: Selected Agentsmentioning

confidence: 99%

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Pharmacologic Management of Common Ailments in Women Who Are Breastfeeding

Dogruluk

2019

J Midwife Womens Health

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According to the Centers for Disease Control and Prevention, the rate of breastfeeding in the United States has increased 34% between 2005 and 2015. Women who breastfeed can require treatment of various common illnesses. When caring for women who are breastfeeding, health care providers may unnecessarily discourage them from breastfeeding during treatment. Choosing the appropriate medications for these individuals is critical to ensure the woman is effectively treated, infant exposure to medication is minimized, and the breastfeeding relationship is preserved. This article provides an overview of essential principles for prescribing medications for women who are lactating. Recommendations for the management of common illnesses seen in the outpatient setting are suggested and resources that can help guide therapeutic decision making are offered.

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Section: Selected Agentsmentioning

confidence: 97%

Section: Selected Agentsmentioning

confidence: 99%

Section: Selected Agentsmentioning

confidence: 99%

Section: Selected Agentsmentioning

confidence: 99%

Section: Selected Agentsmentioning

confidence: 99%

See 3 more Smart Citations

Pharmacologic Management of Common Ailments in Women Who Are Breastfeeding

Dogruluk

2019

J Midwife Womens Health

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Recommendations for the Prescription of Opioids at Discharge After Abdominopelvic Surgery

et al. 2020

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he current epidemic of opioid-related mortality has shed light on poor opioid prescribing practices after abdominopelvic surgery. Research has demonstrated that substantial variations exist in the amount of opioid prescribed at discharge [1][2][3] and that opioid prescriptions are often in excess of actual patient requirements. 1,[3][4][5] These findings are particularly concerning given that more than 70% of patients store their excess opioids in unlocked locations and do not properly dispose of them. 6 Such easily accessible supplies of prescription opioids may lead to unintended harms, such as opioid misuse 7 and accidental overdoses. 8 Moreover, there is growing awareness that a substantial proportion of opioid-naive patients will become long-term users of opioids after initial exposure in the immediate postoperative period. 9-13 Because long-term opioid use may lead to physiological dependence and misuse, prevention in the early phases of perioperative care is important. However, abdominal surgeons may not be aware of the risk of long-term opioid use, and they infrequently perform a risk assessment in their patients. 14 A lack of guidance for surgeons has been cited as a major factor contributing to the suboptimal nature of current postsurgical opioid prescribing practices. 1,14,15 Guidelines published by the American Society of Anesthesiologists and the American Pain Society provide general recommendations on the use of opioids in managing pain during the inpatient postoperative period, but they failed to explicitly address how clinicians should prescribe opioids at discharge. 16,17 Guidelines for the treatment of acute pain from the Centers for Diseases IMPORTANCE The prescription of opioids at discharge after abdominopelvic surgery is variable and often excessive. A lack of guidance for abdominopelvic surgeons may explain the suboptimal nature of current prescribing practices.OBJECTIVE To systematically review existing recommendations on the prescription of opioids at discharge, the appropriate disposal of opioids, and the prevention of chronic postsurgical opioid use after abdominopelvic surgery.EVIDENCE REVIEW This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. From January 2010 to December 2018, a search of MEDLINE, PsycINFO, HealthSTAR, Embase, and the difficult to locate and unpublished (ie, gray) literature was performed using a peer-reviewed strategy with variations of the terms opioid, surgery, and guideline to identify English-language documents that contained recommendations published by professional societies or health care institutions. The quality of clinical practice guidelines was assessed using the Appraisal of Guidelines Research and Evaluation II (AGREE II) tool. A descriptive synthesis of results was performed.FINDINGS Of 5530 citations screened, 41 full-text documents were included in the systematic review. Fifteen clinical practice guidelines were identified. AGREE II domain scores varied substantially. Identified...

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Aspirin (single dose) for perineal pain in the early postpartum period

Shepherd

Grivell

2020

Cochrane Database of Systematic Reviews

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ABM Clinical Protocol #15: Analgesia and Anesthesia for the Breastfeeding Mother, Revised 2017

Cited by 34 publications

References 42 publications

Pharmacologic Management of Common Ailments in Women Who Are Breastfeeding

Pharmacologic Management of Common Ailments in Women Who Are Breastfeeding

Recommendations for the Prescription of Opioids at Discharge After Abdominopelvic Surgery

Aspirin (single dose) for perineal pain in the early postpartum period

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