Oxycodone as a component of multimodal analgesia post-caesarean section in Australia and New Zealand

Background: There is a perception that oxycodone is becoming a popular choice for oral analgesia post Caesarean section (CS), yet there is a lack of published data quantifying its use, or the use of other pharmacological choices, for post CS analgesia in Australasian practice. Aim: To determine current practice with respect to the use of oxycodone and other drug components of multimodal analgesia post CS and assess the compatibility of drugs used with what is known about their safety in breast-feeding Method: FANZCA anaesthetists from 41 Australian and New Zealand obstetric units were invited to participate in an on-line survey containing questions on analgesic preference (drug, routes of administration and dosing schedules) post CS and whether breastfeeding considerations influenced practice. Results: Twenty-five (61 percent of invited participants) completed the survey. All responding units, as part of multimodal analgesic protocols, used oral and rectal paracetamol and non-steroidal anti-inflammatory drugs. Responses indicated that 50 percent of women in metropolitan hospitals and 95 percent in rural/regional hospitals in the survey sample would receive oral or rectal oxycodone post CS and that approximately 15 percent of women would be asked about intention to breastfeed and six percent would have drug choices modified if breastfeeding. Conclusions: All obstetric units surveyed employed a system of multimodal analgesia, with a preference for oral and rectal forms of analgesia over parenteral opioids and NSAIDS. There was a high usage of oxycodone in the sample surveyed. Drug choices were largely compatible with breastfeeding, based on current information on safety of drugs for breast fed infants.