Peripartum and Postpartum Analgesia and Pain in Women Prescribed Buprenorphine for Opioid Use Disorder Who Deliver by Cesarean Section.

IF 2.4 Q3 SUBSTANCE ABUSE
Substance Abuse: Research and Treatment Pub Date : 2022-06-21 eCollection Date: 2022-01-01 DOI:10.1177/11782218221107936
Alane B O'Connor, Joel Smith, Liam M O'Brien, Kaitlyn Lamarche, Nadine Byers, Stephanie D Nichols
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引用次数: 2

Abstract

Aim: Little is known about whether pain can be effectively managed in pregnant women with opioid use disorder (OUD) during delivery hospitalization, particularly those undergoing surgery and taking buprenorphine as medication for OUD (MOUD). To address this question, we compared pain scores and opioid analgesic utilization during delivery hospitalization in women taking their pre-hospital dose of buprenorphine who delivered by cesarean section to matched controls. To inform future research efforts, we also began to explore opioid analgesic utilization and pain scores by type of anesthesia as this variable is often not included in related literature.

Methods: Retrospective matched cohort study of 46 women prescribed buprenorphine during pregnancy who delivered by cesarean section during a 7-year period.

Results: When compared to matched controls, women taking their pre-hospital dose of buprenorphine undergoing cesarean section utilized more opioid analgesics as measured by morphine milligram equivalents (MME) (mean MME first 48 hours 153.0 mg vs 175.1 mg, respectively, P < .01) but had similar pain scores during delivery hospitalization. There was no difference in MME utilization by maternal dose of buprenorphine though sample sizes were small. Women on buprenorphine who received spinal anesthesia with morphine had mean pain scores that were 1.4 points lower (P = .01) during the first 48 hours than women on buprenorphine receiving other methods of anesthesia.

Discussion and conclusions: Pregnant women taking their pre-hospital dose of buprenorphine throughout their surgical delivery hospitalization were able to achieve pain relief similar to women not on MOUD but had higher MME requirements. Our results add to the emerging body of evidence suggesting that individuals on MOUD can achieve adequate post-surgical pain management without adjusting their pre-hospital dose of buprenorphine. Further research is required to fully understand the optimal buprenorphine dosing regimen during surgical hospitalizations. Our results also provide important preliminary evidence that spinal anesthesia containing opioids can be used effectively in individuals with OUD requiring surgical intervention.

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剖宫产孕妇服用丁丙诺啡治疗阿片类药物使用障碍的围生期和产后镇痛和疼痛。
目的:对于患有阿片类药物使用障碍(OUD)的孕妇在分娩住院期间是否能有效控制疼痛,特别是那些接受手术并服用丁丙诺啡作为OUD药物的孕妇,目前知之甚少。为了解决这个问题,我们比较了剖宫产分娩时服用院前丁丙诺啡的妇女在分娩住院期间的疼痛评分和阿片类镇痛药的使用情况。为了为未来的研究工作提供信息,我们也开始探索阿片类镇痛药的使用和麻醉类型的疼痛评分,因为这一变量通常未包括在相关文献中。方法:回顾性匹配队列研究46例剖宫产妊娠期服用丁丙诺啡的妇女。结果:与匹配的对照组相比,剖宫产术中使用院前剂量丁丙诺啡的妇女在前48小时内使用了更多的阿片类镇痛药,以吗啡毫克当量(MME)来衡量(平均MME前48小时分别为153.0 mg和175.1 mg, P P = 0.01)。讨论和结论:孕妇在手术分娩住院期间服用院前剂量的丁丙诺啡能够达到与未服用mod的妇女相似的疼痛缓解,但MME要求更高。我们的研究结果增加了新的证据,表明服用mod的个体可以在不调整院前丁丙诺啡剂量的情况下实现足够的术后疼痛管理。需要进一步的研究来充分了解手术住院期间丁丙诺啡的最佳给药方案。我们的研究结果也提供了重要的初步证据,表明含有阿片类药物的脊髓麻醉可以有效地用于需要手术干预的OUD患者。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
2.70
自引率
4.80%
发文量
50
审稿时长
8 weeks
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