Estimation of infant dose and exposure to pethidine and norpethidine via breast milk following patient-controlled epidural pethidine for analgesia post caesarean delivery

Al-Tamimi, Yasir; Ilett, Kenneth F.; Paech, Michael J.; O’Halloran, Sean; Hartmann, Peter

doi:10.1016/j.ijoa.2010.12.004

Cited by 19 publications

(15 citation statements)

References 37 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Various studies [8][9][10] using continuous opioid infusion (either as a fixed dose or dose based on weight) have failed to identify an ideal dose that would provide adequate analgesia during rest and activity without supplemental bolus doses and prevent side effects [11]. We used a fixed dose of pethidine according to the weight of patient (0.5 mg/kg bolus followed by 0.15 mg/kg continuous infusion per hour), as this is the routine practice and kept the option of rescue analgesia for patients having inadequate pain relief.…”

Section: Discussionmentioning

confidence: 99%

Postoperative Analgesia Following Caesarean Section: Intravenous Patient Controlled Analgesia Versus Conventional Continuous Infusion

Ismail¹,

Afshan²,

Monem³

et al. 2012

OJAnes

View full text Add to dashboard Cite

Background: Management of postoperative pain after caesarean section (CS) requires a balance between pain relief and undesirable side effects of drugs and technique. In order to improve postoperative pain management after caesarean section, we compared intravenous patient controlled analgesia (IV-PCA) with our current hospital practice, which is continuous opioid infusion. Method: We enrolled one hundred and twenty patients in our prospective randomized trial after an uneventful elective caesarean section under spinal anaesthesia. All patients received 0.5 mg/kg bolus of pethidine on first complaint of pain or at 120 minutes after institution of spinal anaesthesia. Depending upon the randomization, Group P received IV-PCA with 0.15 mg/kg bolus pethidine with 10-minute lockout and Group C received continuous pethidine infusion at a rate of 0.15 mg/kg/hr. Statistical Analysis: For qualitative variables means and standard deviations were computed and analyzed by T-test, Mann Whitney U test and repeated measures ANOVA. Frequency and percentages were computed for qualitative data and analyzed by Chi-Square and Fischer exact test. A p-value of less than 0.05 was treated as significant. Results: The numeric rating score for pain, need for rescue analgesia and incidence of nausea and vomiting was significantly lower (p-value < 0.001) in IV-PCA group as compared to continuous infusion group at 6, 12 and 24 hours postoperatively, 98% of the patients were satisfied with pain management in Group P as compared to 70% (p < 0.001) in Group C. Conclusion: Our results showed improved pain control, less need for rescue analgesia for breakthrough pain, lower incidence of nausea and vomiting and greater patient satisfaction with IV-PCA. In the absence of preservative free narcotics for intrathecal use, postoperative pain management can be significantly improved by using IV-PCA instead of continuous opioid infusion in patients undergoing caesarean section.

show abstract

Section: Discussionmentioning

confidence: 99%

Postoperative Analgesia Following Caesarean Section: Intravenous Patient Controlled Analgesia Versus Conventional Continuous Infusion

Ismail¹,

Afshan²,

Monem³

et al. 2012

OJAnes

View full text Add to dashboard Cite

show abstract

“…), however infants exposed to pethidine in this study did not exhibit signs of abnormal or suboptimal breastfeeding behaviour (Al‐Tamimi et al . ; Sakalidis et al . ).…”

Section: Discussionmentioning

confidence: 99%

“…; Al‐Tamimi et al . ). Sparse sampling is a widely used methodology, employed when it is not practical to obtain multiple biological samples and is frequently used in drug studies.…”

Section: Methodsmentioning

confidence: 97%

“…Both pethidine and norpethidine concentrations in the infant plasma, maternal plasma and breast milk were found to be within recommended safety levels (Al‐Tamimi et al . ). In another study on the same cohort, CBP mothers' perceptions of the fullness of the breast, which is associated with secretory activation, occurred significantly later than that of mothers that had a vaginal birth.…”

Section: Introductionmentioning

confidence: 97%

See 1 more Smart Citation

Changes in milk composition associated with pethidine‐PCEA usage after Caesarean section

Tie

Gardner

Lai

et al. 2016

Maternal & Child Nutrition

View full text Add to dashboard Cite

The effect of pethidine as patient-controlled epidural analgesia (PCEA) on specific biochemical components in breast milk in relation to the timing of secretory activation is not well investigated. The aim of this study was to compare biochemical timing of secretory activation between women who had a vaginal (V) or Caesarean birth with pethidine-PCEA (CBP). Several milk samples were collected daily from 36 mothers (17 V, 19 CBP) for the first 265 h post-partum. Protein and lactose concentrations and Na and K ion levels were measured. Samples were assigned to three time periods: 0-72, >72-165 and >165-265 h post-partum for statistical analyses. Data were analyzed using linear mixed effect models. In the first 72 h post-partum, the mean difference in lactose concentration was 5 gL higher in group V (P < 0.05). From >72-165 h post-partum, protein and Na concentrations were lower in group V (P = 0.05, P = 0.02), and K levels were higher in group V (P < 0.001). From >165-265 h post-partum, there were no significant differences between the groups. Biochemically, secretory activation had occurred by 72 h post-partum in both groups. There were greater variations in measured biochemical components observed within group CBP initially. However, by 165 h post-partum, there were no differences in the biochemical components between the groups. This suggests that effects of pethidine-PCEA are diminished by 72 h post-partum and undetected by 165 h.

show abstract

“…Its moderate lipophilicity makes it attractive for epidural administration, after which it provides rapid onset of analgesia and a very low risk of respiratory depression. The estimation of infant dose and exposure to pethidine and norpethidine via breast milk following patient-controlled epidural pethidine for analgesia post caesarean delivery was investigated [113]. The combined absolute infant dose of pethidine and norpethidine received via milk was 1.8% of the neonatal therapeutic dose and the combined relative infant dose was below the 10% recommended safety level.…”

mentioning

confidence: 99%

Effects of Prenatal Opiates Exposure on Human Pregnancy and Breastfeeding

Malek¹

2012

Pharm Anal Acta

View full text Add to dashboard Cite

Opiates like heroin, morphine and their semisynthetic and synthetic analogs act to relieve pain, as well as produce tolerance and physical dependence, by mimicking the various endogenous opioids and by binding to an opioid receptor. Substance use (alcohol, nicotine and illegal drugs including opiates/opioids) and substance use disorders are not uncommon amongst women of reproductive age and during pregnancy. Opioids include naturally occurring, semi-synthetic and synthetic drugs which are used as analgesics; and prescription use of this class of drugs increases during pregnancy over the past decade. Opiates like heroin and methadone are the most commonly used forms by pregnant women. The synthetic opiates such as methadone and buprenorphine are used as substitution therapy for the abused drug like heroin. This class of drugs is both transported to the fetus and alters the placental function. This review summarizes the impact of opiates on the human pregnancy and breastfeeding.

show abstract

Estimation of infant dose and exposure to pethidine and norpethidine via breast milk following patient-controlled epidural pethidine for analgesia post caesarean delivery

Cited by 19 publications

References 37 publications

Postoperative Analgesia Following Caesarean Section: Intravenous Patient Controlled Analgesia Versus Conventional Continuous Infusion

Postoperative Analgesia Following Caesarean Section: Intravenous Patient Controlled Analgesia Versus Conventional Continuous Infusion

Changes in milk composition associated with pethidine‐PCEA usage after Caesarean section

Effects of Prenatal Opiates Exposure on Human Pregnancy and Breastfeeding

Contact Info

Product

Resources

About