Early breastfeeding success not affected by epidural pain relief with fentanyl

November 8, 2017, American Society of Anesthesiologists

Including the opioid fentanyl in the solution used to maintain an epidural during childbirth does not appear to affect the success of breastfeeding six weeks after delivery, according to a study published in Anesthesiology, the peer-reviewed medical journal of the American Society of Anesthesiologists (ASA). Previous research has suggested fentanyl might be associated with early termination of breastfeeding.

Fentanyl is generally used as part of an epidural for pain relief during labor and delivery. It is given with a local anesthetic such as bupivacaine. Using with a local anesthetic allows the use of lower doses of both drugs, which reduces the rate and severity of side effects, explained study lead author Robert J. McCarthy, Pharm.D., research professor of anesthesiology at Northwestern University Feinberg School of Medicine, Chicago. "Local anesthetics can cause muscle weakness and decrease the mother's blood pressure, which can slow the baby's heart rate," said Dr. McCarthy.

The study included 345 women who were randomly assigned to receive one of three epidural solutions: bupivacaine alone, bupivacaine plus 1 microgram per milliliter (μg/ml) of fentanyl, or bupivacaine plus 2 μg/ml of fentanyl. Both doses of fentanyl included in the study are commonly used during labor. 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 labor.

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

"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 centers 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 labor and delivery."

The findings are important because breastfeeding has been shown to have many health benefits for both babies and mothers. Children who are breastfed have improved immunity and mothers who breastfeed have a lower incidence of breast and ovarian cancers and diabetes. "As medical practitioners, it is important to ensure our anesthetic interventions do not impede the mother's or infant's ability to breastfeed," the authors wrote.

In an accompanying editorial, David H. Chestnut, M.D., of Vanderbilt University Medical Center in Nashville, Tennessee, stated the current study provides further support of a favorable risk/benefit ratio for the addition of fentanyl to the solution used to maintain a labor epidural. He also added physician anesthesiologists' 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, Chestnut wrote that some important questions remain unanswered, including the impact much larger doses of fentanyl during prolonged labor in women who have not previously given birth and have no history of successful breastfeeding might have.

Explore further: Fentanyl in more than half of opioid deaths in 10 states

Related Stories

Fentanyl in more than half of opioid deaths in 10 states

October 27, 2017
A federal report says the powerful painkiller fentanyl was involved in more than half of the recent opioid overdose deaths in 10 states.

Fentanyl not recommended for routine use during coronary angiographies

August 29, 2017
In a randomized, double-blind, clinical trial of 212 patients, Johns Hopkins researchers have found that the routine use of fentanyl for sedation and comfort during coronary angiography reduces the effectiveness of the platelet ...

Nose spray offers pain relief in childbirth

January 21, 2016
Pain relief during childbirth may soon be delivered via a self-administered nasal spray, thanks to research from University of South Australia midwifery researcher, Dr Julie Fleet.

Bolus epidural fentanyl cuts post-spinal decompression pain

September 7, 2012
(HealthDay)—Intraoperative bolus epidural fentanyl is effective at alleviating early postoperative pain after lumbar canal decompression, according to a study published online Aug. 27 in The Spine Journal.

Study shows epidurals don't slow labor

October 10, 2017
Epidural analgesia - a mix of anesthetics and narcotics delivered by catheter placed close to the nerves of the spine - is the most effective method of labor pain relief. In widespread use since the 1970s, epidurals have ...

Recommended for you

Complex inhalers prevent patients from taking medicine

February 23, 2018
Respiratory disease patients with arthritis could struggle to manage their conditions because their inhalers are too fiddly for them to use, University of Bath research has found.

Opioid abuse leads to heroin use and a hepatitis C epidemic, researcher says

February 22, 2018
Heroin is worse than other drugs because people inject it much sooner, potentially resulting in increased risk of injection-related epidemics such as hepatitis C and HIV, a Keck School of Medicine of USC study shows.

Opioid addiction treatment behind bars reduced post-incarceration overdose deaths in RI

February 14, 2018
A treatment program for opioid addiction launched by the Rhode Island Department of Corrections was associated with a significant drop in post-incarceration drug overdose deaths and contributed to an overall drop in overdose ...

Heroin vaccine blocks lethal overdose

February 14, 2018
Scientists at The Scripps Research Institute (TSRI) have achieved a major milestone toward designing a safe and effective vaccine to both treat heroin addiction and block lethal overdose of the drug. Their research, published ...

Study shows NIH spent >$100 billion on basic science for new medicines

February 12, 2018
Federally funded research contributed to the science underlying all new medicines approved by the FDA over the past six years, according to a new study by Bentley University.

Opioid use increases risk of serious infections

February 12, 2018
Opioid users have a significantly increased risk of infections severe enough to require treatment at the hospital, such as pneumonia and meningitis, as compared to people who don't use opioids.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.