Acute Pain - final version - Faculty of pain medicine - Australian and ...

Drug
droperidol,
haloperidol
Source:
Key
messages
Comments
Avoid
if
possible,
or
contact
one
of
the
pregnancy
drug
information
centres;
if
used
monitor
infant
for
sedation
Information
taken
with
permission
from
Australian
Medicines
Handbook
2009.
The
following
tick
boxes

represent
conclusions
based
on
clinical
experience
and
expert
opinion.
Prescribing
medications
during
lactation
requires
consideration
of
possible
transfer
into
breast
milk,
uptake
by
the
baby
and
potential
adverse
effects
for
the
baby;
it
should
follow
available
prescribing
guidelines
(U).
Local
anaesthetics,
paracetamol
and
several
non‐selective
NSAIDs,
in
particular
ibuprofen,
are
considered
to
be
safe
in
the
lactating
patient
(U).
Morphine
and
fentanyl
are
considered
safe
in
the
lactating
patient
and
are
preferred
over
pethidine
(U).
11.1.4 Pain management in the puerperium
CHAPTER
11
Pain
during
the
puerperium
is
common
and
of
multiple
aetiologies,
most
often
being
perineal
or
uterine
cramping
pain
initially
and
breast
pain
from
the
fourth
postpartum
day.
Women
are
often
inadequately
warned
and
remain
ill
informed
of
the
best
available
treatments
for
postnatal
pain.
In
the
first
6
months
postpartum,
backache
was
reported
by
44%
of
women
and
perineal
pain
by
21%,
and
many
indicated
they
would
have
liked
more
help
or
advice
(Brown
&
Lumley,
1998).
Severe
perineal
and
uterine
pain
limited
mobility
during
maternalinfant
bonding,
and
perineal
trauma
and
pain
was
associated
with
delayed
resumption
of
sexual
relations
after
birth
(Williams
et
al,
2007
Level
IV).
Breast,
especially
nipple,
pain
may
result
in
abandonment
of
breastfeeding
(Morland‐Schultz
&
Hill,
2005).
Perineal pain
A
number
of
obstetric
and
surgical
factors
contribute
to
perineal
pain
following
delivery.
After
adjusting
for
parity,
perineal
trauma,
and
length
of
labour,
women
with
instrumented
versus
unassisted
vaginal
deliveries
reported
more
perineal
pain
(Thompson
et
al,
2002
Level
IV).
Restrictive
use
versus
routine
mediolateral
episiotomy
reduced
the
rate
of
episiotomy
from
75%
to
28%
and
reduced
the
risk
of
severe
perineal
trauma
and
the
requirement
for
suturing,
but
did
not
influence
the
incidence
or
degree
of
perineal
pain
(Carroli
&
Mignini,
2009
Level
I).
In
comparison
with
interrupted
suturing
methods,
continuous
suturing
(particularly
of
all
layers
rather
than
skin
only)
was
associated
with
reductions
in
pain
and
analgesic
use
(Kettle
et
al,
2007
Level
I).
Non-pharmacological treatments
There
is
only
limited
evidence
to
support
the
effectiveness
of
local
cooling
treatments
(ice
packs,
cold
gel
pads,
cold/iced
baths)
for
relieving
pain
from
perineal
trauma
sustained
during
childbirth,
and
pulsed
electromagnetic
energy
was
more
effective
than
ice
packs
(East
et
al,
2007
Level
I).
Although
improvement
in
perineal
pain
has
been
reported
with
ultrasound,
there
is
insufficient
evidence
to
fully
evaluate
efficacy
(Hay‐Smith,
2000
Level
I).
For
women
without
prior
vaginal
delivery,
antenatal
perineal
massage
(from
35
weeks
gestation)
reduced
the
incidence
of
perineal
trauma
requiring
suturing
(NNT
14;
CI
9
to
35)
and
the
requirement
for
episiotomy
(NNT
23;
CI
13
to
111),
but
values
for
NNT
were
high.
394
 Acute
Pain
Management:
Scientific
Evidence