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The Implementation of a Multimodal Analgesia Protocol for Parturients Treated with Buprenorphine: Impact on Patient Outcomes and Analgesia
Abstract Number: S 35
Abstract Type: Original Research
Introduction: Opioid addiction in parturients is becoming an increasing burden, with a two-fold increase in prevalence of prescription opioid abuse from 1992 to 2008 (1) and an estimated 4.5% of pregnant women abusing illicit substances in 2010 (2). A growing body of evidence is accumulating in support of the use of the opioid agonist-antagonist buprenorphine for opioid maintenance therapy during pregnancy. Multidisciplinary consensus regarding the treatment of postpartum pain in these patients is helpful, and the optimal regimen for the peripartum period is unclear. A tailored management protocol for parturients treated with buprenorphine was initiated at our institution in August of 2012. Its impact on patient outcomes and analgesia was evaluated.
Methods: After IRB approval, a retrospective review was performed of patients admitted to our institution for delivery who were treated with buprenorphine during their pregnancy. Periods of analysis were from January 2006 - July 2012 (pre-protocol) and from August 2012 - December 2012 (post-protocol). Delivery outcomes including buprenorphine dosing interval, usage of multimodal therapy, additional opioid requirements, and Visual Analog Scale (VAS) scores were compared between the two groups. Demographic data was also recorded.
Results: Twenty-five records were reviewed, including 18 patients in the pre-protocol group and 7 patients in the post-protocol group. Results are shown in Table. Notably, there were no statistically significant differences between pre- and post-protocol groups for VAS score or dose of any analgesic. However, patients managed with the protocol had shorter dosing intervals for buprenorphine, trends toward higher buprenorphine, acetaminophen, and ibuprofen use, and lower oxycodone use (p = ns).
Conclusion: A protocol for management of parturients on buprenorphine maintenance therapy was initiated at our institution to streamline the care of these patients. Clinical changes associated with protocol use included a shorter buprenorphine dosing interval and greater use of multimodal therapy, although these changes did not affect patient VAS scores. Our protocol has encouraged multidisciplinary communication among the anesthesia, obstetric, and psychiatric specialties to optimize management of these challenging patients.
1. Jones HE et al. Drugs 2012;72(6):747-757
2. Goodman DJ Midw Wom Health 2011;56:240-247
3. ACOG Op No 524. 2012;119(5):1070-1076