Page 432 Acute Pain Management

Table 11.2 Categorisation of drugs used in pain management
Drug Cat Comments
Opioids
alfentanil, buprenorphine, C Opioid analgesics may cause respiratory
dextromoramide, depression in the newborn infant. Withdrawal
dextropropoxyphene, fentanyl, symptoms in newborn infants have been reported
hydromorphone, methadone, with prolonged use of this class of drugs.
morphine, oxycodone, papaveretum,
pentazocine, pethidine, phenoperidine,
remifentanil, tramadol
codeine, dihydrocodeine A Prolonged high‐dose use of codeine prior to
delivery may produce codeine withdrawal
symptoms in the neonate
Paracetamol A
Aspirin C Aspirin inhibits prostaglandin synthesis. When
given late in pregnancy, it may cause premature
closure of the fetal ductus arteriosus, delay labour
and birth. Aspirin increases the bleeding time both
in the newborn infant and in the mother because
of its antiplatelet effects. Products containing
aspirin should be avoided in the last trimester.
Low‐dose aspirin (100 mg/day) does not affect
bleeding time.
Other nsNSAIDs
diclofenac, diflunisal, ibuprofen, C These agents inhibit prostaglandin synthesis and,
indomethacin, ketoprofen, ketorolac, when given during the latter part of pregnancy,
mefenamic acid, nabumetone, may cause closure of the fetal ductus arteriosus,
naproxen, phenylbutazone, piroxicam, fetal renal impairment, inhibition of platelet
sodium salicylate, sulindac, tenoxicam, aggregation and delayed labour and birth.
tiaprofenic acid Continuous treatment with NSAIDs during the last
trimester of pregnancy should only be given on
sound indications. During the last few days before
expected birth, agents with an inhibitory effect on
prostaglandin synthesis should be avoided.
Coxibs B3

CHAPTER 11 parecoxib C
celecoxib
Local anaesthetics
bupivacaine, cinchocaine, lignocaine
A
(lidocaine), mepivacaine, prilocaine
etidocaine, ropivacaine
procaine hydrochloride B1
B2
levobupivacaine B3
Antidepressants
SSRIs: C SSRIs have had limited use in pregnancy without a
citalopram, fluoxetine, fluvoxamine, reported increase in birth defects. The use of SSRIs
sertraline in the third trimester may result in a withdrawal
state in the newborn infant.
paroxetine D Category changed Sept 2005
384 Acute Pain Management: Scientific Evidence