Colostrum Morphine Concentrations During Postcesarean Intravenous Patient-Controlled Analgesia

Baka, Nour-Eddine; Bayoumeu, F.; Boutroy, Marie‐Jeanne; Laxenaire, M.C.

doi:10.1097/00000539-200201000-00035

Cited by 27 publications

(30 citation statements)

References 9 publications

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“…Colostrum morphine concentrations have been measured during the first 48 hr of post Cesarean iv patient-controlled analgesia. 141 The milk to maternal plasma ratio for morphine was less than one. Morphine was seen in very small concentrations in less than half of the milk samples.…”

Section: Fetal Effects Of Maternal Oxygen Administrationmentioning

confidence: 96%

Effects on the fetus and newborn of maternal analgesia and anesthesia: a review

Littleford

2004

Can J Anesth/J Can Anesth

117

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P Pu ur rp po os se e: : To review the effects of maternal anesthesia and analgesia on the fetus and newborn.M Me et th ho od ds s: : An on-line computerized search of Medline, Embase, and the Cochrane Collaboration via PubMed was conducted. English language articles were selected. The bibliographies of relevant articles and additional material from other published sources were retrieved and reviewed.P Pr ri in nc ci ip pa al l f fi in nd di in ng gs s: : No one test clearly separates the effects on the fetus/newborn, if any, of maternally administered medication during labour and delivery, or during surgery for non-obstetric indications. Supposition in this regard is limited in part by methodology previously used to study the transplacental passage of various drugs. This work needs to be repeated using a human model. Routine maternal supplemental oxygen administration is being questioned in light of research showing that free radical generation and oxidative stress are implicated as the underlying mechanisms in several neonatal conditions. Maternal hypotension is associated with neonatal acidemia and base excess correlates with neonatal outcome. Common postpartum analgesics transfer minimally into breast milk. Maternal or fetal surgery conducted during pregnancy necessitates modification of both anesthetic and surgical approaches. The key to resuscitation of the fetus is resuscitation of the mother: intra-uterine maneuvers, including perimortem Cesarean section, aim to reverse treatable causes of fetal asphyxia, restore fetal oxygenation, and correct fetal acidosis.C Co on nc cl lu us si io on ns s: : The well-being of the infant is a major criterion for evaluating the anesthetic management of pregnant women. Many tools exist to assist with this determination for the fetus, whereas few are available to evaluate the newborn. Méthode : Une recherche informatisée en ligne des bases Medline et Embase et du Centre de collaboration Cochrane via PubMed a été réalisée. Des articles de langue anglaise ont été sélectionnés. Les bibliographies d'articles pertinents et du matériel additionnel d'autres publications ont été retenus et passés en revue. Constatations principales : Aucun test ne sépare clairement les effets sur le foetus/nouveau-né, si effet il y a, des médicaments administrés à la mère pendant le travail et l'accouchement ou pendant une intervention chirurgicale non obstétricale. Les hypothèses possibles

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Section: Fetal Effects Of Maternal Oxygen Administrationmentioning

confidence: 96%

Effects on the fetus and newborn of maternal analgesia and anesthesia: a review

Littleford

2004

Can J Anesth/J Can Anesth

117

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“…About 6% of the weight-adjusted maternal dose of morphine is transferred in breast milk (Feilberg et al, 1989), but the oral bioavailability in the infant is low (about 25%), so only small amounts reach the infant. In mothers treated with IV PCA morphine for 48 hours following Caesarean section, levels of morphine and M6G were low in breast milk, suggesting minimal drug would be transferred to the neonate (Baka et al, 2002).…”

Section: Opioids and Tramadolmentioning

confidence: 99%

Safety of opioid patch initiation in Australian residential aged care

Gadzhanova

Roughead

Pont

2015

Medical Journal of Australia

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Objective: To explore opioid use by aged care facility residents before and after initiation of transdermal opioid patches. Design: A cross‐sectional cohort study, analysing pharmacy data on individual patient supply between 1 July 2008 and 30 September 2013. Setting: Sixty residential aged care facilities in New South Wales. Participants: Residents receiving an initial opioid patch during the study period. Main outcome measure: The proportion of residents who were opioid‐naive in the 4 weeks prior to patch initiation was determined. In addition, the patch strength at initiation and the daily dose of transdermal patches and of additional opioids 1 month after initiation were determined. Results: An opioid patch was initiated in 596 of 5297 residents (11.3%: 2.6% fentanyl, 8.7% buprenorphine) in the 60 residential aged care facilities. The mean age at initiation was 87 years, and 74% of the recipients were women. The proportion of recipients who were opioid‐naive before patch initiation was 34% for fentanyl and 49% for buprenorphine. Most were initiated at the lowest available patch strength, and the dose was up‐titrated after initiation. Around 15% of fentanyl users and 10% of buprenorphine users needed additional regular opioids after patch initiation. Conclusions: The results suggest some inappropriate initiation of opioid patches in Australian residential aged care facilities. Contrary to best practice, a third of residents initiated on fentanyl patches were opioid‐naive in the 4 weeks before initiation.

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“…It has been reported that infants may receive between 0.8-12% of the maternal morphine oral dose and concentrations of up to 1,084 ng/ ml of morphine-6-glucoride were found in breast milk of mothers using PCA. 29,30 These levels may be dangerous to newborns, infants, and toddlers; and thus close attention must be paid to the infant when mother is receiving this medication. Nevertheless, low-dose morphine is frequently the opioid of choice as passage to breast milk is the less than with other narcotic agents.…”

Section: The Effect Of Postpartum or Postoperative Medicationsmentioning

confidence: 99%

Breastfeeding after Anesthesia: A Review for Anesthesia Providers Regarding the Transfer of Medications into Breast Milk

Cobb

Liu

Valentine

et al. 2015

Transl Perioper & Pain Med

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Brief Summary:Doctors, nurses, and midwives often inform mothers to "pump and dump" their breast milk for 24 hours after receiving anesthesia to avoid passing medications to the infant. This advice, though cautious, is probably outdated. This review highlights the more recent literature regarding common anesthesia medications, their passage into breast milk, and medication effects observed in breastfed infants. We suggest continuing breastfeeding after anesthesia when the mother is awake, alert, and able to hold her infant. We recommend multiple types of medications for pain relief while minimizing sedating medications. Few medications can have sedating effects to the infant, but those medications are specifically outlined. For additional safety, anesthesia providers and patients may screen medications using the National Institute of Health' LactMed database. INTRODUCTIONThe positive impact of breastfeeding for both mothers and infants has been well established.1, 2 Given the difficulty of conducting randomized clinical trials in breastfeeding mothers and their infants however, there is a paucity of human data regarding the transfer of anesthesia and analgesia medications into breast milk. Available information remains limited to case studies, small sample observations, and animal studies, which may or may not accurately reflect conditions for lactating women. 3,4 This lack of knowledge may lead mothers who require medication to abandon nursing on their own accord or based on conservative advice from healthcare practitioners who are concerned about possible adverse effects in the infant. 5 In addition, physicians, hospitals, and even patients continue to rely on the information given by drug manufacturers concerning the use of drugs during breastfeeding, which is often restrictive or similarly contains contraindications for the lactation period. The lack of agreement among physicians, the FDA, and hospital policy has created different recommendations and practices regarding, 1) the interval between medication administration and breastfeeding, 2) when to "pump and dump", and most importantly, 3) which medications are safe. This review highlights the most recent medical literature concerning breastfeeding and the perioperative use of common medications by anesthesia providers during the intraoperative, intrapartum, postoperative and postpartum periods. 6 The review is focused only on opioid-naïve patients as evidence addressing recommendations in opioid-tolerant lactating mothers remain non-existent. Information presented in this review is written on the premise that data is limited and most medications administered in this patient population have not been rigorously screened by the FDA for safety and efficacy. EVIDENCEThe transfer of medications into breast milk depends on pharmacological properties including protein binding, lipid solubility, molecular weight, pKa, and maternal plasma level of the drug. 7 In general, medications that are highly lipid soluble, less protein-bound, of lower molecular weight, or wit...

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Colostrum Morphine Concentrations During Postcesarean Intravenous Patient-Controlled Analgesia

Cited by 27 publications

References 9 publications

Effects on the fetus and newborn of maternal analgesia and anesthesia: a review

Effects on the fetus and newborn of maternal analgesia and anesthesia: a review

Safety of opioid patch initiation in Australian residential aged care

Breastfeeding after Anesthesia: A Review for Anesthesia Providers Regarding the Transfer of Medications into Breast Milk

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