November 9, 2017

Early Breastfeeding Success Not Affected by Epidural Pain Relief With Fentanyl

CHICAGO -- November 9, 2017 -- Including the opioid fentanyl in the solution used to maintain an epidural during childbirth does not appear to affect the success of breastfeeding 6 weeks after delivery, according to a study published in Anesthesiology.

Previous research has suggested fentanyl might be associated with early termination of breastfeeding.

Using fentanyl with a local anesthetic allows the use of lower doses of both drugs, which reduces the rate and severity of side effects, explained Robert J. McCarthy, PharmD, Northwestern University Feinberg School of Medicine, Chicago, Illinois. “Local anaesthetics can cause muscle weakness and decrease the mother's blood pressure, which can slow the baby's heart rate.”

The study included 345 women who were randomised to receive one of 3 epidural solutions: bupivacaine alone, bupivacaine plus fentanyl μg/ml, or bupivacaine plus fentanyl 2 μg/ml. All of the women in the study were more than 38 weeks pregnant, planned to breastfeed, had successfully breastfed a prior infant, and had received an epidural during a past labour.

The study found the frequency of breastfeeding at 6 weeks was 97% in those receiving bupivacaine alone, 98% in those receiving the solution with fentanyl 1 μg/ml, and 94% in those receiving the solution with fentanyl 2 μg/ml.

“We found that when fentanyl is used in moderate amounts in an epidural solution, we did not see any adverse consequences in breastfeeding in women who had planned to breastfeed and had done so successfully before,” said Dr. McCarthy.

The concern about fentanyl centres on the possibility that fentanyl might transfer from mother to baby through the placenta and depress the nervous system of the infant.

“An infant does not have a liver that is mature enough to process drugs the way adults do,” said Dr. McCarthy. “Our study appears to show that this does not occur at doses commonly given during labour and delivery.”

The findings are important because breastfeeding has been shown to have many health benefits for both babies and mothers.

“As medical practitioners, it is important to ensure our anaesthetic interventions do not impede the mother’s or infant’s ability to breastfeed,” the authors wrote.

In an accompanying editorial, David H. Chestnut, MD, Vanderbilt University Medical Center, Nashville, Tennessee, stated the current study provides further support of a favourable risk/benefit ratio for the addition of fentanyl to the solution used to maintain a labour epidural.

He also added physician anaesthesiologists’ encouragement of breastfeeding positively intersects with postpartum analgesia and enhanced-recovery-after-delivery protocols, as well as strategies to reduce postpartum opioid use before and after hospital discharge. However, Dr. Chestnut wrote that some important questions remain unanswered, including the impact much larger doses of fentanyl during prolonged labour in women who have not previously given birth and have no history of successful breastfeeding might have.

SOURCE: American Society of Anesthesiologists

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