When used epidurally or intravenously during labor or for a short time immediately postpartum, amounts of sufentanil ingested by the neonate are small and would not be expected to cause any adverse effects in breastfed infants. Because of sufentanil's long half-life during continued intravenous infusion or repeated intravenous administration, sufentanil levels in milk would be expected to increase if used for an extended period postpartum. Because there is no published experience with repeated doses of intravenous sufentanil during established lactation, other agents may be preferred, especially while nursing a newborn or preterm infant. If sufentanil is required by the mother, it is not a reason to discontinue breastfeeding, but once the mother's milk comes in, it is best to limit maternal intake and to supplement analgesia with a nonnarcotic analgesic if necessary. If the baby shows signs of increased sleepiness (more than usual), difficulty breastfeeding, breathing difficulties, or limpness, a physician should be contacted immediately.
Sufentanil is metabolized to a minimally active and inactive metabolites. The oral bioavailability of sufentanil is unknown. Therapeutic plasma levels from intravenous sufentanil during surgery in adults are 0.25 to 8 mcg/L. The usual intravenous dosage of sufentanil for anaesthesia in an infant during surgery is 10 to 15 mcg/kg. Lower dosages 0.25 to 1 mcg/kg are used for analgesia. Sufentanil is also commonly administered epidurally. Plasma levels are markedly lower when the epidural route is used.
Nine women who had undergone cesarean section received sufentanil 50 mcg epidurally immediately after delivery. Sufentanil was undetectable (<0.1 mcg/L) in colostrum at about 1 hour after the dose.
Twenty-nine women undergoing cesarean section received 20 mcg of epidural sufentanil prior to surgery and were then randomized to receive either an epidural anaesthetic combined with sufentanil 3.75 mcg per hour plus 1.25 mcg every 20 minutes as needed via a patient-controlled epidural analgesia (PCEA) device, or an epidural anaesthetic alone via PCEA with no sufentanil. Breastmilk was sampled on postpartum days 1, 2 and 3. Sufentanil was detected in breastmilk in all groups. Levels were highest in the group receiving postpartum sufentanil via PCEA; however, cumulative sufentanil dosages were not reported. Milk levels were apparently low in the other 2 groups. Reporting errors in this study do not allow for estimation of infant sufentanil dose from milk.
Relevant published information was not found as of the revision date.
Effects in Breastfed Infants:
Newborns of breastfeeding mothers who received epidural sufentanil before and after cesarean section delivery were reportedly not clinically affected and had no differences in behavior or clinical signs over 3 days postpartum compared to newborns of mothers who received epidural sufentanil prior to delivery only.
Possible Effects on Lactation:
Narcotics can increase serum prolactin. However, the prolactin level in a mother with established lactation may not affect her ability to breastfeed.
1. Hansdottir V, Woestenborghs R, Nordberg G. The pharmacokinetics of continuous epidural sufentanil and bupivacaine infusion after thoracotomy. Anesth Analg. 1996;83:401-6. PMID:8694326 2. Madej TH, Strunin L. Comparison of epidural fentanyl with sufentanil. Anaesthesia. 1987;42:1156-61. PMID:2963561 3. Cuypers L, Wiebalck A, Vertommen JD et al. Epidural sufentanil for postcesarean pain: breast milk levels and effects on the baby. Acta Aneasthiol Belg. 1995;46:104-5. 4. Tolis G, Dent R, Guyda H. Opiates, prolactin, and the dopamine receptor . J Clin Endocrinol Metab. 1978;47:200-3. PMID:263291 5. Frecska E, Perenyi A, Arato M. Blunted prolactin response to fentanyl in depression. Normalizing effect of partial sleep deprivation. Psychiatry Res. 2003;118:155-64. PMID:12798980
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