Challenges that opioid-dependent women present to the obstetric anaesthetist.
A retrospective casenote review was performed to identify anaesthetic challenges relevant to the opioid-dependent obstetric population. Medical records showed that of the 7,449 deliveries during a 24 month period, 85 women (1.1%) were taking regular opioids such as methadone and/or heroin. Of these 67 (79%) received anaesthetic services, ten of whom (11.7%) were referred antenatally. Forty opioid-dependent women (47%) received epidural analgesia in labour compared with the overall hospital rate of 38%. Twenty-three women (27%) delivered by caesarean section: five received general anaesthesia, five combined spinal anaesthesia, five spinal anaesthesia and eight epidural anaesthesia. Twenty opioid-dependent women (23.5%) had documented problems related to labour analgesia and 17 (74%) had problems with analgesia after caesarean section. A variety of postoperative analgesia methods were administered in addition to maintenance methadone. Fourteen patients (16.5%) had difficult intravenous access and seven "arrest" calls were documented. One anaesthetist was exposed to hepatitis C. This review demonstrates the demands placed on obstetric anaesthetic services by opioid-dependent women. Early antenatal referral for anaesthetic review is recommended.
Cassidy
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B
Women's and Children's Hospital, Adelaide, South Australia.
Cyna
A M
AM
D000328:Adult; D016362:Analgesia, Obstetrical / Q000009:adverse effects / Q000379:methods; D016058:Analgesia, Patient-Controlled; D000773:Anesthesia, Obstetrical / Q000009:adverse effects / Q000379:methods; D002585:Cesarean Section; D005260:Female; D006556:Heroin Dependence / Q000175:diagnosis / Q000534:rehabilitation; D006801:Humans; D008691:Methadone / Q000627:therapeutic use; D010149:Postoperative Pain / Q000188:drug therapy; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis
D008691:Methadone