Re: ACOG Antepartum Record - Pain Scale?
From: Garry E. Siegel, M.D. (garrys@mindspring.com)
Sat Nov 24 15:47:54 2007
FWIW, by habit and teaching I rarely use codeine anyway.
I generally use Oxycodone/Acetaminophen (Percocet) or
Hydrocodone/Acetaminophen (Lortab or Vicodin) and have used a good bit
of Dilaudid in oral and PCA form lately.
Garry
At Sat, 24 Nov 2007, Joanne Bulley, MD wrote:
>
>About 6 months ago our hospital clinical monitoring committee reviewed
>the information about some people being "rapid metabolizers" of codeine
>(into morphine) and thus able to get much higher levels of morphine in
>the blood stream with the complications of excess narcotics and all that
>entails.
>
>So we reminded all docs about this and Anna's recommendations fit right
>into that issue.
>
>Joanne
>
>At Fri, 23 Nov 2007, Meenan, Anna wrote:
>>
>>A small percentage of moms (it varies by ethnicity) rapidly
>>metabolize codeine to morphine. I wouldn't say codeine is
>>contraindicated in breastfeeding moms, but needs to be given for only
>>a few days, and if pain continues, the situation needs to be
>>re-evaluated, which is why I have to keep reminding my residents not
>>to send more than 2 or 3 days worth of T3 home with breastfeeding
>>moms and to tell them to call if still having pain requiring
>>narcotics when that runs out.
>>
>>Anna Meenan, MD
>>
>>>In the UK a post Caesarean breast feeding patient kept complaining
>>>of pain (no apparant cause) and was given repeated doses of
>>>codeine.There was a neonatal death on day 15 suspected to be due to
>>>resp.depression.Therefore now is strictly contraindicated in breast
>>>feeding women
>>>Aditi
>>>
>>>>>>----- Original Message ----
>>>From: "art fougner, md" <evsono@pipeline.com>
>>>To: Multiple recipients of list OB-GYN-L <ob-gyn-l@dns.obgyn.net>
>>>Sent: Wednesday, 21 November, 2007 5:47:57 PM
>>>Subject: Re: ACOG Antepartum Record - Pain Scale?
>>>
>>>She's Dead, Joe.
>>>
>>>Art
>>>
>>>At Wed, 21 Nov 2007, <mailto:DoctorJoe@aol.com>DoctorJoe@aol.com wrote:
>>>
>>>>You know, (1) you can't trust the patient not to be faking, and (2) you
>>>>don't want to be embarrassed by a lawyer ("Didn't you see, Nurse
>>>>Jones, that when
>>>>you recorded 'asleep' the patient wasn't breathing and his tongue was
>>>>lolling out to the side? The patient was DEAD, Nurse Jones, he was DEAD!!")
>>>>
>>>>Joe P.
>>>
>>>--
>>>art fougner, md
>>>"May The Wings of Liberty Never Lose a Feather." - Jack Burton
>>>
>>>For ideas on reducing your carbon footprint visit
>>><http://uk.promotions.yahoo.com/forgood/environment.html>Yahoo! For
>>>Good this month.
>
>--
>Joanne Bulley, MD, FACOG
>Solo gyn
>Keene, NH USA
>
--
Garry E. Siegel, M.D.
Private Practice
Roswell, GA
