The use of oxycodone for analgesia post caesarean section: maternal plasma levels, breast milk levels and neonatal levels; survey of use in Australian and New Zealand obstetric units.
Seaton, S (2008) The use of oxycodone for analgesia post caesarean section: maternal plasma levels, breast milk levels and neonatal levels; survey of use in Australian and New Zealand obstetric units. Research Master thesis, University of Tasmania.
Drug transfer to the feeding infant and the safety of a transferred drug are
important considerations for clinicians, yet there is a paucity of reliable studies in
humans. Drug product manufacturers are not mandated to provide studies on the
transfer oftheir products into human milk and may advise that the drug not be used
in breastfeeding mothers, due to lack of information. This often leads to the
cessation of the drug, resulting in suboptimal treatment of the mother, or the highly
undesirable outcome of cessation of breastfeeding.
There was a perception that the opioid analgesic drug, oxycodone, was becoming a
popular choice for oral analgesia post-Caesarean section. A review of the literature
revealed no information or recommendations for its use in this setting, and
manufacturers advised that the drug should not be used in breastfeeding.
Fifty breastfeeding mothers, taking oxycodone, had blood and breast milk samples
analysed for oxycodone levels at 24-hourly intervals after Caesarean section. Fortyone
neonates had blood samples analysed at 48 hours and 72 hours after delivery.
Oxycodone was detected in milk of all mothers taking any dose of the drug in the
previous 24 hours. The maximum level recorded in milk was 168 ng/m!. There was
a strong linear correlation between the maternal blood levels and the milk levels
and there was evidence of persistence of oxycodone in the milk of some mothers,
up to 37 hours after the last maternal dose. Oxycodone was detected in the plasma
of one neonate of 41 tested.
The risk of neonatal exposure was assessed to be minimal in the three days post
delivery because of the low volumes of milk ingested by neonates in this period.
The benefits of providing effective and convenient analgesia to aid successful
initiation of breastfeeding and enable mothers to care for their babies would appear
to outweigh the risks of infant exposure to oxycodone in this early period.
The findings in this study are not generalisable to the transfer of oxycodone into
mature milk, or exposure of older infants whose mothers may be taking this drug.
It would be prudent to be cautious and monitor infants for signs of sedation, poor
feeding, gastrointestinal symptoms and respiratory depression if mothers are on
large doses of oxycodone.
To determine current practice with respect to the use of oxycodone and other drug
components of multi modal analgesia post-Caesarean section 25 Fellows of the
Australian and New Zealand College of Anaesthetists completed an on-line survey.
Responses indicated that 50 percent of women in metropolitan hospitals and 95
percent in ruraVregional hospitals, in the survey sample, would receive oral or
rectal oxycodone post-Caesarean section. The popularity of oxycodone as a choice
for analgesia in this setting supports the importance of this study.
|Item Type:||Thesis (Research Master)|
|Deposited By:||UTAS ePrints officer|
|Deposited On:||28 Apr 2011 15:10|
|Last Modified:||11 Dec 2012 12:04|
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