Breastfeeding after Anesthesia: A Review for Anesthesia Providers Regarding the Transfer of Medications into Breast Milk
Benjamin Cobb, Renyu Liu, Elizabeth Valentine, Onyi Onuoha, Benjamin Cobb, Renyu Liu, Elizabeth Valentine, Onyi Onuoha
Abstract
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 This advice, though cautious, is probably outdated.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.
References
- Kramer MS. “Breast is best”: The evidence. Early Human Development. 2010;86(11):729–732.
- Section on B, et al. Breastfeeding and the use of human milk. Pediatrics. 2012;129(3):e827–41.
- Chu TC, McCallum J, Yii MF. Breastfeeding after anaesthesia: a review of the pharmacological impact on children. Anaesth Intensive Care. 2013;41(1):35–40.
- Nassen CA, et al. Anesthesia and analgesia in the lactation period. Criteria for drug selection. Anaesthesist. 2014;63(5):415–21.
- Ito N, et al. Contribution of Protein Binding, Lipid Partitioning, and Asymmetrical Transport to Drug Transfer into Milk in Mouse Versus Human. Pharmaceutical Research. 2013;30(9):2410–2422.
- Dalal PG, Bosak J, Berlin C. Safety of the breast-feeding infant after maternal anesthesia. Paediatr Anaesth. 2014;24(4):359–71.
- Hale TW. Maternal medications during breast-feeding. Clin Obstet Gynecol. 2004;47(3):696–711.
- Braveman FR, S B, Wong CA, Santos AC. Obstetrical Anesthesia. In: C B, Barash PG, Stoelting RK, Cahalan MK, Stock MC, editors. Clinical Anesthesia. Lippincott Williams & Wilkins; Philadelphia: 2009. pp. 1137–1170.
- Ortega D, et al. Excretion of lidocaine and bupivacaine in breast milk following epidural anesthesia for cesarean delivery. Acta anaesthesiologica Scandinavica. 1999;43(4):394–7.
- Madej TH, Strunin L. Comparison of epidural fentanyl with sufentanil. Analgesia and side effects after a single bolus dose during elective caesarean section. Anaesthesia. 1987;42(11):1156–61.
- Chay PC, Duffy BJ, Walker JS. Pharmacokinetic-pharmacodynamic relationships of morphine in neonates. Clin Pharmacol Ther. 1992;51(3):334–42.
- Feilberg VL, et al. Excretion of morphine in human breast milk. Acta Anaesthesiol Scand. 1989;33(5):426–8.
- Dailland P, et al. Intravenous propofol during cesarean section: placental transfer, concentrations in breast milk, and neonatal effects. A preliminary study. Anesthesiology. 1989;71(6):827–34.
- Esener Z, et al. Thiopentone and etomidate concentrations in maternal and umbilical plasma, and in colostrum. Br J Anaesth. 1992;69(6):586–8.
- Dalal PG, Berlin C. Response to Silvani and Camporesi, regarding their comment on our paper Safety of the breast-feeding infant after maternal anesthesia. Paediatr Anaesth. 2014;24(4):453–4.
- Nitsun M, et al. Pharmacokinetics of midazolam, propofol, and fentanyl transfer to human breast milk. Clin Pharmacol Ther. 2006;79(6):549–57.
- Montgomery A, Hale TW, Academy M. Of Breastfeeding, ABM clinical protocol #15: analgesia and anesthesia for the breastfeeding mother, revised 2012. Breastfeed Med. 2012;7(6):547–53.
- Steer PL, et al. Concentration of fentanyl in colostrum after an analgesic dose. Canadian journal of anaesthesia = Journal canadien d’anesthesie. 1992;39(3):231–5.
- Stocki D, et al. A randomized controlled trial of the efficacy and respiratory effects of patient-controlled intravenous remifentanil analgesia and patient-controlled epidural analgesia in laboring women. Anesthesia and analgesia. 2014;118(3):589–97.
- Stuttmann R, et al. The breast feeding mother and xenon anaesthesia: four case reports. Breast feeding and xenon anaesthesia. BMC anesthesiology. 2010;10:1.
- Klehmet J, Dudenhausen J, Meisel A. [Course and treatment of myasthenia gravis during pregnancy]. Verlauf und Behandlung der Myasthenia gravis in der Schwangerschaft. Der Nervenarzt. 2010;81(8):956–62.
- Davis JE. Paracervical block in obstetrics and gynecology. Calif Med. 1966;105(6):421–3.
- Baker PA, Schroeder D. Interpleural bupivacaine for postoperative pain during lactation. Anesthesia and analgesia. 1989;69(3):400–2.
- Needs CJ, Brooks PM. Antirheumatic medication during lactation. Br J Rheumatol. 1985;24(3):291–7.
- Wittels B, Scott DT, Sinatra RS. Exogenous opioids in human breast milk and acute neonatal neurobehavior: a preliminary study. Anesthesiology. 1990;73(5):864–9.
- Kuhnert BR, et al. Disposition of meperidine and normeperidine following multiple doses during labor. II. Fetus and neonate. Am J Obstet Gynecol. 1985;151(3):410–5.
- Koren G, et al. Pharmacogenetics of morphine poisoning in a breastfed neonate of a codeine-prescribed mother. Lancet. 2006;368(9536):704.
- Edwards JE, et al. Hydromorphone transfer into breast milk after intranasal administration. Pharmacotherapy. 2003;23(2):153–8.
- Robieux I, et al. Morphine excretion in breast milk and resultant exposure of a nursing infant. J Toxicol Clin Toxicol. 1990;28(3):365–70.
- Baka NE, et al. Colostrum morphine concentrations during postcesarean intravenous patient-controlled analgesia. Anesth Analg. 2002;94(1):184–7. table of contents.
- Gadsden J, Hart S, Santos AC. Post-cesarean delivery analgesia. Anesth Analg. 2005;101(5 Suppl):S62–9.
- Hirose M, et al. The effect of postoperative analgesia with continuous epidural bupivacaine after cesarean section on the amount of breast feeding and infant weight gain. Anesth Analg. 1996;82(6):1166–9.
Source: PubMed