Codeine for Acute Pain Related to Caesarean Section #MMPMID34255445
Hill S; Argaez C
Codeine for Acute Pain Related to Caesarean Section-/-CADTH Health Technology Review 2021[Mar]; ä (ä): ä PMID34255445show ga
Caesarean section (C-section) is a method of birth through an incision in the abdominal wall and uterine wall.(,) C-section rates have steadily increased worldwide in the last 3 decades. In Canada, C-section birth rates increased by approximately 50.8% from 1997 to 2016. C-section births may be planned or unplanned if there are complications that arise before birth or during labour. These complications may include an adverse position of the baby close to the due date, health conditions for the pregnant patient that may be worsened due to the stress of labour, chances of vertical transmission of a pre-existing infection to the baby, labour that is slow or stops completely, or signs of distress shown by the baby during labour.(,) Hospital recovery after a C-section birth typically lasts 2 to 5 days; however, it may take weeks to months for a full recovery.(,) Acute pain can be described as pain caused by something specific and does not last longer than 6 months. Acute pain in the abdominal region is common after a C-section birth, and pain medications containing codeine, alone or in combination with nonsteroidal anti-inflammatory drugs (NSAIDs), have been used in the past to subdue post-operative pain.(,) Oral codeine is hepatically metabolized by the polymorphic CYP2D6 enzyme to a clinically active metabolite (i.e., morphine). Because of this metabolization process, oral codeine has the potential for drug interactions and adverse effects may be unpredictable due to interindividual differences in metabolism of codeine into morphine. In Canada, codeine-containing products are authorized to relieve pain or suppress cough; however, there may be safety issues with the use of codeine in postpartum patients.(-) Specifically, in postpartum patients who are breastfeeding there is the potential for neonatal toxicity from prolonged codeine exposure,(,)(,) and there is the potential for central nervous system depression caused by opioid toxicity in both postpartum patients and breastfed babies. There are additional concerns with opioid use worldwide including inappropriate prescribing, opioid addiction and dependency, and opioid-related deaths, and Canada is the second-highest consumer of opioids. It is important to determine whether the clinical benefits of opioid use in patients who have undergone C-section outweigh the potential risks. Four other CADTH reports have reviewed the clinical effectiveness of codeine with or without accompanying NSAIDs for acute pain related to osteoarthritis of the knee and hip, urological or general surgery, orthopedic surgery, and for acute pain in pediatric patients. The purpose of this report is to evaluate the clinical effectiveness of codeine with or without acetaminophen or other NSAIDs for patients with acute pain who have undergone C-section.
Codeine+for+Acute+Pain+Related+to+Caesarean+Section-/-CADTH+Health+Technology+Review 2021 ; ä (ä): ä
