Epidural fentanyl at concentrations up to 2 mcg/mL does not effect breastfeeding rates in women who have previously successfully breastfed.

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• Amy I Lee, Robert J McCarthy, Paloma Toledo, Mary Jane Jones, Nancy White, and Cynthia A Wong.
• From the Department of Anesthesiology, Memorial Hermann Memorial City Medical Center, Houston, Texas (A.I.L.); Department of Anesthesiology (R.J.M., P.T., M.J.J.) and Center for Healthcare Studies (P.T.), Northwestern University Feinberg School of Medicine, Chicago, Illinois (R.J.M., P.T.); Department of Nursing, Northwestern Memorial Hospital Chicago, Illinois (N.W.); and Department of Anesthesia, University of Iowa Carver College of Medicine, Iowa City, Iowa (C.A.W.).
• Anesthesiology. 2017 Oct 1; 127 (4): 614-624.

BackgroundBreastfeeding is an important public health concern. High cumulative doses of epidural fentanyl administered for labor analgesia have been reported to be associated with early termination of breastfeeding. We tested the hypothesis that breastfeeding success is adversely influenced by the cumulative epidural fentanyl dose administered for labor analgesia.MethodsThe study was a randomized, double-blind, controlled trial of parous women at greater than 38 weeks gestation who planned to breastfeed, had successfully breastfed a prior infant, and who received neuraxial labor analgesia. Participants were randomized to receive one of three epidural maintenance solutions for labor analgesia (bupivacaine 1 mg/ml, bupivacaine 0.8 mg/ml with fentanyl 1 μg/ml, or bupivacaine 0.625 mg/ml with fentanyl 2 μg/ml). The primary outcome was the proportion of women breastfeeding at 6 weeks postpartum. Maternal and umbilical venous blood fentanyl and bupivacaine concentration at delivery were measured.ResultsA total of 345 women were randomized and 305 had complete data for analysis. The frequency of breastfeeding at 6 weeks was 97, 98, and 94% in the groups receiving epidural fentanyl 0, 1, and 2 μg/ml, respectively (P = 0.34). The cumulative fentanyl dose (difference: 37 μg [95% CI of the difference, -58 to 79 μg], P = 0.28) and maternal and umbilical cord venous fentanyl and bupivacaine concentrations did not differ between women who discontinued breastfeeding and those who were still breastfeeding at 6 weeks postpartum.ConclusionsLabor epidural solutions containing fentanyl concentrations as high as 2 μg/ml do not appear to influence breastfeeding rates at 6 weeks postpartum.

This article appears in the collection: Breastfeeding and epidural fentanyl.

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