title: The effect of nefopam on lactation after caesarean section: a single-blind randomised trial.
abstract: BACKGROUND
  Nefopam is a centrally acting analgesic which has a theoretical risk of stopping lactation due to its anticholinergic and dopaminergic effects. The aim of this study was to evaluate the effect of nefopam on lactation and to investigate potential adverse effects on newborns.
  
  
  METHODS
  Seventy-two women, scheduled to undergo a caesarean delivery under spinal anaesthesia and wanting to breastfeed, were randomised to one of two groups: nefopam (20mg, six hourly) or paracetamol (1g, six hourly). In both groups, postoperative analgesia was supplemented with ketoprofen (50mg, six hourly) in conjunction with intrathecal morphine 0.1mg. The primary outcome was onset of lactation, estimated by weighing the newborns before and after feeding; by maternal perception of breast fullness and based on serum prolactin concentration 48hours postpartum. Secondary outcomes were neonatal adverse effects evaluated by neurobehavioural score at 12, 24, 48, and 72hours after birth. Statistical analyses were performed using Chi-squared, Fisher exact and Student t tests as appropriate. P<0.05 was considered statistically significant.
  
  
  RESULTS
  The difference in the weight of the newborn before and after each feed, maternal perception of breast fullness and serum prolactin did not significantly differ between groups. The volume of artificial milk given to newborns of mothers in the nefopam group on days two and three was significantly greater than for the paracetamol group. Neurobehavioural scores were comparable at each time point.
  
  
  CONCLUSIONS
  Nefopam does not appear to delay the onset of lactation or present any clear risk to the newborn.
authors.affiliation: Department of Anaesthesia and Intensive Care, Maternité Régionale, Centre Hospitalier Régional Universitaire of Nancy, France. Electronic address: n.baka@chu-nancy.fr.
authors.forename: N E
authors.initials: NE
authors.lastname: Baka
authors.affiliation: Department of Anaesthesia and Intensive Care, Maternité Régionale, Centre Hospitalier Régional Universitaire of Nancy, France.
authors.forename: F
authors.initials: F
authors.lastname: Vial
authors.affiliation: Department of Anaesthesia and Intensive Care Medicine, Cork University Hospital, Ireland.
authors.forename: G
authors.initials: G
authors.lastname: Iohom
authors.affiliation: Department of Anaesthesia and Intensive Care, Brabois Hospital, Centre Hospitalier Régional Universitaire of Nancy, France.
authors.forename: P
authors.initials: P
authors.lastname: Guerci
authors.affiliation: Neonatal Intensive Care Unit, Maternité Régionale, Centre Régional Universitaire of Nancy, France.
authors.forename: C
authors.initials: C
authors.lastname: Hubert
authors.affiliation: Neonatal Intensive Care Unit, Maternité Régionale, Centre Régional Universitaire of Nancy, France.
authors.forename: M
authors.initials: M
authors.lastname: Rouabah
authors.affiliation: Department of Anaesthesia and Intensive Care, Maternité Régionale, Centre Hospitalier Régional Universitaire of Nancy, France.
authors.forename: H
authors.initials: H
authors.lastname: Bouaziz
mesh_terms: D000082:Acetaminophen / Q000009:adverse effects / Q000627:therapeutic use; D000328:Adult; D018712:Analgesics, Non-Narcotic / Q000009:adverse effects* / Q000627:therapeutic use; D000773:Anesthesia, Obstetrical; D000775:Anesthesia, Spinal; D001835:Body Weight; D001942:Breast Feeding / Q000523:psychology; D002585:Cesarean Section; D005260:Female; D006801:Humans; D018730:Infant Behavior; D007231:Infant, Newborn; D007774:Lactation / Q000187:drug effects*; D009340:Nefopam / Q000009:adverse effects* / Q000627:therapeutic use; D010149:Postoperative Pain / Q000188:drug therapy; D011247:Pregnancy; D011388:Prolactin / Q000097:blood; D016037:Single-Blind Method
chemical_list: D018712:Analgesics, Non-Narcotic; D000082:Acetaminophen; D009340:Nefopam; D011388:Prolactin
keywords: Caesarean delivery; Lactation; Nefopam