Postpartum Pain Management
- 1 July 2018
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Obstetrics & Gynecology
- Vol. 132 (1), E35-E43
- https://doi.org/10.1097/AOG.0000000000002683
Abstract
Pain and fatigue are the most common problems reported by women in the early postpartum period. Pain can interfere with a woman's ability to care for herself and her infant. Untreated pain is associated with a risk of greater opioid use, postpartum depression, and development of persistent pain. Nonpharmacologic and pharmacologic therapies are important components of postpartum pain management. Because 81% of women in the United States initiate breastfeeding during the postpartum period, it is important to consider the drug effects of all prescribed medications on the mother-infant dyad. Multimodal analgesia uses drugs that have different mechanisms of action, which potentiates the analgesic effect. If opioids are included, a multimodal regimen used in a stepwise approach allows for administration of lower doses of opioids. Given interindividual variation in metabolism of opioids, as well as the risk of maternal and neonatal adverse effects in women who are ultra-rapid metabolizers of codeine, monitoring for excessive sedation and other adverse effects in infants is prudent for women who are prescribed opiates. Although the U.S. Food and Drug Administration recommendations underscore the need for anticipatory guidance regarding opioid effects in all patients, obstetrician-gynecologists and other obstetric care providers should ensure that the application of this guidance does not interfere with pain control or disrupt breastfeeding during the postpartum period. Women with opioid use disorder, women who have chronic pain, and women who are using other medications or substances that may increase sedation need additional support in managing postpartum pain.This publication has 52 references indexed in Scilit:
- The Transfer of Drugs and Therapeutics Into Human Breast Milk: An Update on Selected TopicsPediatrics, 2013
- A Clinical Tool for Reducing Central Nervous System Depression among Neonates Exposed to Codeine through Breast MilkPLOS ONE, 2013
- Effect of dexamethasone on prevention of postoperative nausea, vomiting and pain after caesarean sectionEuropean Journal of Anaesthesiology, 2013
- Transversus abdominis plane block reduces postoperative pain intensity and analgesic consumption in elective cesarean delivery under general anesthesiaJournal of Anesthesia, 2012
- Clinical Pharmacogenetics Implementation Consortium (CPIC) Guidelines for Codeine Therapy in the Context of Cytochrome P450 2D6 (CYP2D6) GenotypeClinical Pharmacology & Therapeutics, 2011
- Genetic polymorphisms and drug interactions modulating CYP2D6 and CYP3A activities have a major effect on oxycodone analgesic efficacy and safetyBritish Journal of Pharmacology, 2010
- Severity of acute pain after childbirth, but not type of delivery, predicts persistent pain and postpartum depressionPain, 2008
- Postoperative Analgesic Effects of Continuous Wound Infiltration with Diclofenac after Elective Cesarean DeliveryAnesthesiology, 2007
- Pharmacokinetics of codeine and its metabolite morphine in ultra-rapid metabolizers due to CYP2D6 duplicationThe Pharmacogenomics Journal, 2006
- Evaluation of different doses of soluble ibuprofen and ibuprofen tablets in postoperative dental painBritish Journal of Oral and Maxillofacial Surgery, 1996