Management of a parturient on buprenorphine for labor and delivery
Abstract Number: 126
Abstract Type: Case Report/Case Series
Chronic pain syndromes are becoming increasingly common in the obstetric population. Managing pain during labor as well as subsequent vaginal or cesarean delivery can be challenging to the anesthesiologist.
We present a 37- year -old parturient at 38 weeks gestational age for vaginal delivery. The patient has been on Buprenorphine 8mg tid for chronic low back pain for three years previous to pregnancy. She had been switched from buprenorphine/naloxone at the onset of pregnancy due to the potential risks of naloxone to the fetus. The obstetric plan was for vaginal delivery. The strategy for pain management was to continue Buprenorphine at 8mg tid, along with placing an epidural catheter for labor. The epidural infusion consisted of Ropivicane 0.2% with Fentanyl 2 mcg/cc running at 10cc/hour. If the patient required a cesarean delivery, we then would use the catheter for the procedure by administering lidocaine 2% with an additional 50mcg of fentanyl epidurally. Epidural morphine would be withheld and we would utilize a fentanyl IV PCA to manage post-operative pain.
The patient had a vaginal delivery. After the epidural catheter was removed a fentanyl IV PCA was started at 5mcg q15minutes for post op pain control. She utilized the PCA for three days with superior comfort. The patient also continued buprenorphine post delivery after an extensive discussion about its risks and benefits during breastfeeding. The patient was weaned off the fentanyl pca and given a fentanyl transdermal patch of 25 mcg q72hrs. Upon discharge, the patient was sent home with a prescription for the fentanyl patch 25mcg q72hrs for the upcoming week and was advised to consult with her pain management physician for further follow-up and management.
Literature describing the use of buprenorphine during pregnancy is well documented in Europe, and is fast gaining popularity in the United States as a safe and effective method to manage chronic pain. The use of adjuncts may indeed be required, and anesthesiologists must be aware of multimodal pain management strategies to effectively treat parturients during labor and delivery.