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Peripartum Care of the Opioid Dependent Parturient: A Survey
Abstract Number: F3H-72
Abstract Type: Original Research
Opioid use and abuse is a national epidemic that deserves special attention in pregnancy. Opioid related deaths have quadrupled over the last 15 years, neonatal abstinence syndrome has increased by over 300% since year 2000, and maternal opioid use complicates 5.8/1000 hospital births. The unpredictability of delivery, inconsistency in prenatal care, and psychiatric and medical co-morbidities add complexity to the already difficult task of acute pain management in opioid dependent women. Since an ideal care pathway for these patients is not defined, we hypothesized that SOAP members would have variable practices/approaches to their care.
In order to define current approaches to this patient population, a survey was sent in spring of 2018 to all SOAP members regarding their personal and institutional practices around opioid dependent parturient. Respondents answered ten questions regarding the location and type of practice, practice patterns, and whether their institution approaches opioid dependent patients in an intentional way that is distinct from the care of an otherwise healthy parturient.
We received 240 responses. Of these, 94 (38%) identified themselves as a section head or chair within their institution. Two hundred and nineteen (90%) of responders report almost always using intrathecal morphine for treatment of pain after cesarean section. Only 31 (12%) respondents reported that these patients are “always” seen by an anesthesiologist prior to delivery while others reported that this occurs sometimes (112, 45%), not usually (55, 23%), or almost never (44, 18%). Of responders, 162 (70%) reported buprenorphine or methadone are “almost always” continued as prescribed while the remaining 30% were unsure if the drugs are continued. Notably, 53 responders (22%) report having a standardized approach for opioid dependent patients around the time of delivery while 61 (25%) would like to have more guidance on how to approach these patients. Greater than 75% of respondents report using long acting neuraxial opioids, scheduled NSAIDs, and scheduled acetaminophen in their approach to this population, while less than half utilize post-operative epidural analgesia, patient controlled intravenous opioids, or transversus abdominis plane blocks. Less than 20% report utilizing intravenous ketamine and several responders free texted on the use of neuraxial clonidine, gabapentinoids, or lidocaine patches. Perceived contact with this patient population was as follows: 28 (10%) daily contact, 57 (23.3%) once per week, 71 (29%) once per month, 61 (25%) a few times per years, and 23 (9%) almost never.
This survey demonstrates variability within SOAP membership in the care of opioid dependent parturients. This survey data suggests the need for discussion, education, and expert consensus on the optimal care pathway for opioid dependent mothers.