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A retrospective review of anesthetic management and postoperative analgesic consumption of parturients on buprenorphine maintenance therapy undergoing cesarean delivery
Abstract Number: F3I-502
Abstract Type: Original Research
Parturients using buprenorphine maintenance therapy pose a unique challenge to the obstetric anesthesiologist when presenting for cesarean delivery (CD). We performed this retrospective study to assess postoperative opioid consumption (POC) and the analgesic regimens used in parturients on buprenorphine maintenance therapy at our institution.
A retrospective chart review was conducted to identify the medical records of patients taking buprenorphine who underwent CD at our institution from January 1, 2014 through December 31, 2018. We extracted demographic, obstetric, anesthetic and postpartum analgesic data to characterize our population. Total opioid consumption was measured in milligram morphine equivalents (MME) at 24-hour intervals following delivery. Descriptive statistics were used to describe our cohort. We also performed a regression analysis to examine the effect of daily dose of buprenorphine, the use of intrathecal clonidine, and the use of post-operative epidural analgesia on POC at 24 and 72 hours.
We identified 34 patients taking buprenorphine maintenance therapy who underwent CD in the time period of interest. Ten patients in the cohort had an existing epidural catheter placed for labor analgesia prior to converting to CD, 13 had a single shot subarachnoid block, and the remaining 11 patients had a combined spinal-epidural anesthetic for planned CD. All patients in the cohort received neuraxial morphine and post-operative multimodal analgesia with scheduled acetaminophen and nonsteroidal anti-inflammatory drugs. Their daily buprenorphine dose was continued during the hospital stay. The characteristics of this population are summarized in the Table. In the regression analysis, total daily dose of buprenorphine was significantly associated with POC at both 0-24 hours (p = 0.03) and at 0-72 hours (p < 0.0001). The use of intrathecal clonidine and postoperative epidural analgesia were not associated with POC at those time points.
In this small retrospective study, women on buprenorphine maintenance therapy had high opioid requirements in the postoperative period. Higher amounts of pre-operative buprenorphine for chronic opioid dependence were associated with increased POC following CD. Additional research is required to identify the most effective pain management strategies for this patient population.