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首页> 外文期刊>Prescrire international >Relief of moderate nociceptive pain in breastfeeding women: Non-pharmacological measures first, then paracetamol or ibuprofen
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Relief of moderate nociceptive pain in breastfeeding women: Non-pharmacological measures first, then paracetamol or ibuprofen

机译：缓解母乳喂养女性中度伤害性疼痛：第一个，然后是扑热息痛或布洛芬的非药理学措施

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A large number of common painful conditions are called "nociceptive", i.e. they are caused by damage to tissues or organs other than the nervous system. For example in a breastfeeding woman, this may be due to an episiotomy, breast engorgement, etc. The initial approach to relief of moderate nociceptive pain is to search for the cause and to use non-pharmacological measures. Analgesic drugs taken by a lactating woman pass into the milk, and the breastfed baby is exposed to their adverse effects. Drug concentrations in the milk are generally close to maternal plasma levels, but the clinical consequences for the breastfed child vary, depending on numerous factors, and have in general been poorly evaluated. What is the harm-benefit balance of analgesic drugs in this setting? We have reviewed the available evidence, using the standard Prescrire methodology. Paracetamol, or alternatively ibuprofen, are drugs on which little data is available, but for which there is extensive experience of use and no apparent safety signal in healthy breastfed babies. The dosage must be kept under control, and it should never exceed the maximum dose appropriate for the situation. The lowest effective dose should be used, and treatment should be discontinued as soon as it is no longer needed. The plasma elimination half-life of naproxen is significantly longer than that of ibuprofen, and serious adverse effects have been reported in children exposed to maternal naproxen via breastfeeding. For moderate to severe pain, opioids are often used. Morphine, a so-called strong opioid, is the first-choice opioid analgesic, used at the minimum effective dose. The other so-called strong opioids (fentanyl, oxycodone, etc.) do not appear to have a better harm-benefit balance than that of morphine, which also has a more predictable analgesic efficacy. Opioids taken by the mother can cause respiratory depression, neurological problems, etc., in breastfed babies. It is best to avoid repeated administration of morphine while breastfeeding, or alternatively to suspend breastfeeding to allow time for the drug to be cleared. In the meantime, the baby can be given formula milk, which has very little harmful effect on health, unless access to safe drinking water cannot be guaranteed. Codeine exposes breastfed babies to serious, sometimes fatal, adverse effects which are difficult to predict. Difficulty in suckling, lethargy, somnolence, constipation, cyanosis, respiratory depression, and bradycardia were observed in about one hundred newborns exposed to codeine via breast milk. Given their variable metabolism in mother and baby, the same effects may be expected with tramadol, dihydrocodeine, and oxycodone. If one of these drugs is nevertheless chosen, it is advisable to suspend breastfeeding to allow time for clearance of the drug, while expressing and discarding the milk in order to maintain lactation. Other opioids such as powdered opium, tapen-tadol, fentanyl, hydromorphone or sufentanil should also be avoided during breastfeeding. As a precaution, nefopam should also be avoided.
机译：许多常见的疼痛状态被称为“伤害性”，即它们是由神经系统以外的组织或器官损伤引起的。例如，在哺乳期妇女中，这可能是由于会阴切开、乳房充血等。缓解中度伤害性疼痛的最初方法是寻找原因并使用非药物措施。哺乳期妇女服用的止痛药会进入母乳，母乳喂养的婴儿会受到其不良影响。母乳中的药物浓度通常接近母亲的血浆水平，但母乳喂养的孩子的临床后果因多种因素而有所不同，并且总体上评估较差。在这种情况下，止痛药的利弊平衡是什么？我们使用标准的Prescrire方法对现有证据进行了审查。扑热息痛（Paracetamol）或布洛芬（ibuprofen）是一种数据不多的药物，但在健康的母乳喂养婴儿中有广泛的使用经验，且没有明显的安全信号。剂量必须得到控制，且不得超过适合该情况的最大剂量。应使用最低有效剂量，一旦不再需要，应立即停止治疗。萘普生的血浆清除半衰期明显长于布洛芬，据报道，通过母乳喂养接触母体萘普生的儿童会出现严重的不良反应。对于中度至重度疼痛，经常使用阿片类药物。吗啡，一种所谓的强阿片类药物，是首选的阿片类镇痛剂，以最低有效剂量使用。其他所谓的强阿片类药物（芬太尼、羟考酮等）似乎没有比吗啡更好的利弊平衡，吗啡也有更可预测的镇痛效果。母亲服用阿片类药物会导致母乳喂养婴儿出现呼吸抑制、神经系统问题等。最好避免在母乳喂养时重复服用吗啡，或者暂停母乳喂养，以便有时间清除药物。与此同时，婴儿可以获得配方奶，这对健康的危害很小，除非无法保证获得安全饮用水。可待因会使母乳喂养的婴儿受到难以预测的严重、有时甚至致命的不良影响。在大约100名通过母乳接触可待因的新生儿中观察到哺乳困难、嗜睡、嗜睡、便秘、发绀、呼吸抑制和心动过缓。考虑到它们在母亲和婴儿体内的代谢变化，曲马多、二氢可待因和羟考酮也可能产生同样的效果。如果仍然选择了其中一种药物，建议暂停母乳喂养，以便有时间清除药物，同时分泌和丢弃母乳，以维持哺乳。母乳喂养期间也应避免使用其他阿片类药物，如鸦片粉、泰本泰多、芬太尼、氢吗啡酮或舒芬太尼。作为预防措施，还应避免使用奈福泮。

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    《Prescrire international》 |2020年第221期|共2页
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