Analgesia and Anesthesia in Breastfeeding Mothers

Introduction

Breastfeeding has many benefits for infants and mothers. Infants exclusively go for mothers to feed for up to six months. Then, however, they keep feeding on the mother's milk for up to two years with complementary diets. The breastfeeding process blooms the mother-baby relationship. Breast milk of the mother includes fats, proteins, vitamins, and immunity cells. But the composition keeps on varying with the mother's nutrition. So, whatever mothers eat or have is expressed in the mother's feed. So, the medicine given to the mother during surgery is also excreted in the mother's milk and can affect the baby.

What Are Analgesia and Anesthesia Drugs?

Analgesic is the medicine or drug used to relieve pain. A few analgesic medicines are:

• Non-Steroidal Anti-inflammatory Drugs (NSAIDS) - Paracetamol, Ibuprofen, Diclofenac, Celecoxib, Ketorolac, Aspirin.

• Opioids - Morphine, Codeine, Tramadol, Hydromorphone, Remifentanil.

Anesthetic drugs or medicine are used for temporary loss of sensation of a body part or a complete state of unconsciousness. It also provides pain relief. A few anesthetic drugs are:

• Volatile Agents - Sevoflurane, Isoflurane, Desflurane, Nitrous oxide, Halothane.

• Intravenous Agents - Midazolam, Diazepam, Dexmedetomidine, Propofol, Ketamine.

• Neuromuscular Blockers - Rocuronium, Vecuronium.

What Are Analgesic and Anesthetic Drugs Used in the Breastfeeding Mothers?

Analgesic and anesthesia drugs are used in surgery. Breast milk also passes these drugs. Some medicines are expressed at low levels, and others at high levels. Here are a few pills with a display of safe or not safe for lactating mothers.

Analgesic Drugs:

• NSAIDs - They are primarily suitable for breastfeeding mothers; although it passes through, the milk effect is minimal.

• Paracetamol and Ibuprofen - They are very safe and effective for analgesia in postpartum mothers.

• Diclofenac - It is commonly used in postpartum analgesia because breast milk levels are low.

• Celecoxib - It should minimally be used in the short term in women. Advantageous in cases of maternal bleeding.

• Ketorolac - It is the most commonly used postpartum analgesia, especially after Cesarean sections. The milk levels are deficient, so it is pretty safe to use.

• Opioids - Opioids are the most concerning in the class of drugs requiring extra attention. They have shown unsafe results on infants. So, cautious usage of opioids should be done.

• Morphine - It is transferred to breast milk in small quantities. A single dose of morphine will not affect the infant, but the continued dosages can cause an infant respiratory depression.

• Codeine - Codeine is not safe for breastfeeding mothers. Codeine has a higher concentration in breast milk which can cause neonates depression or death. And if, in any case, the drug is used in breastfeeding mothers, then discarding the breast milk for 15 hours is required to eliminate the effect.

• Dihydrocodeine - It is widely used in Cesarean and breastfeeding mothers as it is a weak opioid.

• Tramadol - It is completely inhibited in breastfed mothers because it has shown cases of respiratory depression and the death of infants.

• Remifentanil - It is also considered safe for milk mothers.

• Hydromorphone - It is excreted at low levels into breast milk, but still, it is not considered entirely safe to use.

Anesthetic Drugs:

• Propofol - Propofol is transferred to breast milk in minimal amounts. The breastfeeding process can start after the surgery.

• Ketamine - Ketamine should be used very cautiously in breastfeeding mothers.

• Midazolam - It is considered safe for use as deficient levels of these drugs are found in breast milk.

• Dexmedetomidine - It should be cautiously used in breastfeeding mothers.

• Neuromuscular Blockers - They are safe and used in breastfeeding mothers.

• Neuromuscular Blocker Reversal Drugs - They are also safe to use.

• Volatile Agents - Sevoflurane, Isoflurane, and Desflurane are volatile agents. They get rapidly cleared and are safe to use.

• Local Anesthesia - It can be used safely with lactating mothers during labor pains.

What Are the Recommendations for Breastfeeding Mothers?

There are some recommendations suggested for breastfeeding mothers going for surgery. They are:

• The implication of drugs used in mothers depends upon many factors, including the infant's age, the length of lactation, and the ability of infants to clear the medication.

• All anesthetic and analgesic drugs transfer to breast milk, and only low levels in milk are considered acceptable.

• As breastfeeding gets affected by the pain, the mother should not avoid pain medicine.

• Cesarean delivery should go with the epidurals and spinal blocks, as they are safe.

• Patients should resume breast milk soon after the surgery.

• General anesthesia generally turns off quickly on waking, making it suitable for the mother to feed the baby.

• Mothers who have undergone dental treatment with a single dose of medication should feed the infants soon after waking.

• Mothers who have undergone plastic surgery with extensive use of local anesthesia should pump and discard the milk for 12 hours before feeding.

• Apnea and hypotension infants should prevent feeding after their mother's medication for at least 12 to 24 hours.

What Are the Preoperative and Postoperative Management of Breastfeeding Patients?

Preoperative management includes:

• Women who are breastfeeding should not preferably stop breastfeeding routines.

• If the patient is separated from the infant for more hours, then the patient should store the milk, and feeding can be done during the mother's surgical hours.

• If the infant is not encouraged to bottle feed before surgery, it should be encouraged to bottle feed.

• The time for surgery should be managed by the mother so that the child's routine for breastfeeding should not get disturbed.

Postoperative management includes:

• The patient should start breastfeeding as soon as she recovers from the surgery.

• There is no need to "pump and discard" milk after anesthesias.

• Breastfeeding for mothers should be accessible after surgery.

• Patients should not sleep while breastfeeding after the surgical procedures; a guardian should look after the mother and child.

What Are the Contraindications for Breastfeeding Mothers?

Contraindications are:

• Codeine, Tramadol, and Oxycodone opioid medicine.

• Aspirin analgesic medicine.

• A child who is suffering from apnea and hypotension.

Conclusion

Breastfeeding mothers have some considerations before breastfeeding the infants after the surgery. First, the medication varies for them to keep minimal concentration in the breast milk. The drugs used during anesthesia and after surgery are usually expressed in low levels in women's milk. Paracetamol and Ketorolac are analgesics; anesthetic includes Propofol, Ketamine, and Midazolam which are commonly used and relatively safe for breastfeeding mothers. This article explains that the mother should never boycott breastfeeding the child even after undergoing surgery; the medication doses are limited by doctors for breastfeeding mothers. In some cases, the mother should take 12 hours lapse from feeding to redeem the ill effects of the medication on the infants.