Dr. Gopika Hari and Dr. Lana Joudeh join the podcast to discuss the literature on the safety of peripartum opioid use and its implications for breastfeeding.

Dr. Hari is an anesthesia resident in the MGH Anesthesia Residency Program and a graduate of Washington University School of Medicine in St. Louis. Dr. Joudeh completed her anesthesia residency at Massachusetts General Hospital and is currently a faculty member. This episode was produced as part of the Depth of Anesthesia podcast elective.

Thanks for listening! If you enjoy our content, leave a 5-star review on Apple Podcasts and share our content with your colleagues.

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Follow us on Instagram @DepthofAnesthesia for podcast and literature updates.

Email us at depthofanesthesia@gmail.com with episode ideas or if you'd like to join our team.

Music by Stephen Campbell, MD.

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References

​American Society of Anesthesiologists. Statement on Resuming Breastfeeding after Anesthesia. Amended October 23, 2024. Available at: https://www.asahq.org/standards-and-practice-parameters/statement-on-resuming-breastfeeding-after-anesthesia. Accessed April 6, 2025.

Mitchell J, Jones W, Winkley E, Kinsella SM. Guideline on anaesthesia and sedation in breastfeeding women 2020: Guideline from the Association of Anaesthetists. Anaesthesia. 2020 Nov;75(11):1482-1493. doi: 10.1111/anae.15179. Epub 2020 Aug 1. PMID: 32737881.

Pharmacologic Stepwise Multimodal Approach for Postpartum Pain Management: ACOG Clinical Consensus No. 1. Obstet Gynecol. 2021 Sep 1;138(3):507-517. doi: 10.1097/AOG.0000000000004517. PMID: 34412076.

Robieux I, Koren G, Vandenbergh H, Schneiderman J. Morphine excretion in breast milk and resultant exposure of a nursing infant. J Toxicol Clin Toxicol. 1990;28(3):365-70. doi: 10.3109/15563659008994437. PMID: 2231835.

Baka, N.-E., Bayou Menu, F., Boutroy, M.-J., & Laxenaire, M.-C. (2002). Colostrum morphine concentrations during Postcesarean intravenous patient-controlled analgesia. Anesthesia & Analgesia, 94(1), 184–187. https://doi.org/10.1213/00000539-200201000-00035

Wittels B, Glosten B, Faure EA, et al. Postcesarean analgesia with both epidural morphine and intravenous patient-controlled analgesia: neurobehavioral outcomes among nursing neonates. Anesth Analg. 1997;85(3):600-606.

Lam J, Kelly L, Ciszkowski C, et al. Central nervous system depression of neonates breastfed by mothers receiving oxycodone for postpartum analgesia. J Pediatr. 2012;160(1):33-37.e2.

Seaton, S., Reeves, M., & McLean, S. (2007). Oxycodone as a component of multimodal analgesia for lactating mothers after Cesarean section: relationships between maternal plasma, breast milk and neonatal plasma levels. The Australian & New Zealand journal of obstetrics & gynecology, 47(3), 181–185. https://doi.org/10.1111/j.1479-828X.2007.00715.x

Edwards, J. E., Rudy, A. C., Wermeling, D. P., Desai, N., & McNamara, P. J. (2003). Hydromorphone Transfer into Breast Milk After Intranasal Administration. Pharmacotherapy, 23(2), 153–158. https://doi.org/10.1592/phco.23.2.153.32081

Oommen, H., Oddbjørn Tveit, T., Eskedal, L. T., Myr, R., Swanson, D. M., & Vistad, I. (2021). The association between intrapartum opioid fentanyl and early breastfeeding: A prospective observational study. Acta obstetricia et gynecologica Scandinavica, 100(12), 2294–2302. https://doi.org/10.1111/aogs.14268

Goma, H. M., Said, R. N., & El-Ela, A. M. (2008). Study of the newborn feeding behaviors and fentanyl concentration in colostrum after an analgesic dose of epidural and intravenous fentanyl in cesarean section. Saudi medical journal, 29(5), 678–682.

Stocki D, Matot I, Einav S, Eventov-Friedman S, Ginosar Y, Weiniger CF. A randomized controlled trial of the efficacy and respiratory effects of patient-controlled intravenous remifentanil analgesia and patient-controlled epidural analgesia in laboring women. Anesthesia & Analgesia. 2014;118(3):589-597.

Dr. Jess Hawkins joins the show to discuss the literature pertaining to remifentanil and opioid-induced hyperalgesia. Dr. Hawkins is an anesthesia resident at the Massachusetts General Hospital.

This podcast was recorded as part of the Depth of Anesthesia podcast elective.

Thanks for listening! If you enjoy our content, leave a 5-star review on Apple Podcasts and share our content with your colleagues.

—

Follow us on Instagram @DepthofAnesthesia and on Twitter (X) @DepthAnesthesia for podcast and literature updates.

Email us at depthofanesthesia@gmail.com with episode ideas or if you'd like to join our team.

Music by Stephen Campbell, MD.

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References

Peter Yi, MD, Peter Pryzbylkowski, MD, Opioid Induced Hyperalgesia, Pain Medicine, Volume 16, Issue suppl_1, October 2015, Pages S32–S36, https://doi.org/10.1111/pme.12914

Angst MS, Koppert W, Pahl I, Clark DJ, Schmelz M. Short-term infusion of the mu-opioid agonist remifentanil in humans causes hyperalgesia during withdrawal. Pain. 2003 Nov;106(1-2):49-57. doi: 10.1016/s0304-3959(03)00276-8. PMID: 14581110

Joly V, Richebe P, Guignard B, Fletcher D, Maurette P, Sessler DI, Chauvin M. Remifentanil-induced postoperative hyperalgesia and its prevention with small-dose ketamine. Anesthesiology. 2005 Jul;103(1):147-55. doi: 10.1097/00000542-200507000-00022. PMID: 15983467

Fletcher D, Martinez V. Opioid-induced hyperalgesia in patients after surgery: a systematic review and a meta-analysis. Br J Anaesth. 2014 Jun;112(6):991-1004. doi: 10.1093/bja/aeu137. PMID: 24829420

Comelon M, Raeder J, Stuhaug A, et al. Gradual withdrawal of remifentanil infusion may prevent opioid-induced hyperalgesia. Br J Anaesth 2016; 116: 524–30