Management of Nonobstetric Pain During Pregnancy and Lactation

Rathmell, James P.; Viscomi, Christopher M.; Ashburn, Michael A.

doi:10.1097/00000539-199711000-00021

Cited by 46 publications

(55 citation statements)

References 72 publications

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“…The principles of passage of drugs in human milk (Ito, 2000;Berlin & Briggs, 2005;Ilett & Kristensen, 2005) including drugs relevant to pain management (Rathmell et al, 1997;Spigset & Hagg, 2000;Bar-Oz et al, 2003) have been reviewed. The maternal plasma concentration, which is influenced by the dose and the ability of the mother to metabolise the drug, is an important determinant of drug levels in milk.…”

Section: Pain Management During Lactationmentioning

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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Section: Pain Management During Lactationmentioning

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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“…In deciding drug therapy, we should consider any potential for harm to the mother, the fetus, and the course of pregnancy. The most effective and safe drug regimen for treatment of pain during pregnancy remains controversial [5]. IDs may be associated with bleeding complications, premature closure of the ductus arteriosus and oligohydramnios [9].…”

Section: Discussionmentioning

confidence: 99%

Pain Management in a Parturient with Presacral Mass

Ru¹,

Lew²,

Yian³

et al. 2017

OJAnes

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Presacral masses are rare lesions and due to obscure anatomic location and etiological heterogeneity, they pose a diagnostic and therapeutic challenge. Literature is limited on the pain management of a parturient with presacral mass. We describe here a parturient in her second trimester with severe pain from a presacral mass. A high clinical acumen with early multidisciplinary involvement are needed to establish a diagnosis and provide treatment options for the well-being of the patient, minimize fetal teratogenicity, avoid chronic symptoms and long-term disability.

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“…The neonatal dose of most medications obtained through breastfeeding is 1 to 2% of the maternal dose. 140 Breast milk content also affects the extent of drug transfer from maternal plasma. For instance, lipid soluble drugs are less likely to accumulate in colostrum, which contains little fat.…”

Section: Fetal Effects Of Maternal Oxygen Administrationmentioning

confidence: 99%

“…When evaluating the possibility of teratogenicity from maternally administered anesthetic medications, points to be considered include: 140,144 1. The incidence of congenital anomalies in the developed world is 3%; 2.…”

Section: Fetal Effects Of Maternal Oxygen Administrationmentioning

confidence: 99%

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

Littleford

2004

Can J Anesth/J Can Anesth

118

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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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Management of Nonobstetric Pain During Pregnancy and Lactation

Cited by 46 publications

References 72 publications

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

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

Pain Management in a Parturient with Presacral Mass

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

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