Use of which of the following medications would MOST likely necessitate a delay in resumption of breastfeeding after surgery?

Lactating patients have traditionally been advised to avoid breastfeeding for a period after surgery and anesthesia, and to discard breast milk in a process known as “pump and dump.” Recently, recommendations have changed, and many medications used in the perioperative period are considered low risk for immediate resumption of breastfeeding (Figure). Many opioid analgesics are considered safe based on relative infant dose (RID), a term denoting neonatal drug exposure. RID (expressed as a percentage) is the amount of the medication delivered in breast milk divided by the normal dose of the medication. For example, the amount of fentanyl taken in breast milk would be about 1% of a safe intravenous dose. It is important to note that preterm infants are at increased risk of sedation from opioids; these recommendations...

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