Intrapartum and postpartum analgesia for women maintained on methadone during pregnancy.
OBJECTIVE
To determine whether methadone maintenance alters intrapartum or postpartum pain or medication requirements.


METHODS
Sixty-eight patients treated with methadone for opiate dependence during pregnancy (vaginal n=35; cesarean n=33) were matched retrospectively to control women. Analgesic medication and pain scores (0-10) were extracted from the medical record. The primary endpoint was opiate use postpartum (oxycodone equivalents). The secondary endpoints were pain scores and intrapartum analgesia.


RESULTS
There were no differences in intrapartum pain or analgesia. After vaginal birth, methadone-maintained women experienced increased pain (methadone, 2.7 [1.9-5.0]; control, 1.4 [0.5-3.0], P=.001) but no increase in opiate use ([mean+/-standard deviation] methadone 12.7+/-32.1; control 6.8+/-12.7 mg/24 h, P=.33); after cesarean delivery both pain (methadone, 5.3 [4.1-6.0]; control, 3.0 [2.2-3.9], P=.001) and opiate use (methadone, 91.6+/-51.8; control, 54.0+/-18.6 mg/24 h, P=.001) increased.


CONCLUSIONS
Methadone-maintained women have similar analgesic needs and response during labor, but require 70% more opiate analgesic after cesarean delivery.


METHODS
II.
Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, and the Department of Statistics, University of Vermont College of Medicine, Burlington, VT 05401, USA. marjorie.meyer@uvm.edu
Marjorie
M
Meyer
Katherine
K
Wagner
Anna
A
Benvenuto
Dawn
D
Plante
Diantha
D
Howard
D000293:Adolescent; D000328:Adult; D016058:Analgesia, Patient-Controlled; D000701:Analgesics, Opioid / Q000494:pharmacology*; D016022:Case-Control Studies; D002585:Cesarean Section; D005260:Female; D005283:Fentanyl / Q000494:pharmacology; D006801:Humans; D048949:Labor Pain / Q000188:drug therapy / Q000503:physiopathology*; D008691:Methadone / Q000494:pharmacology*; D010147:Pain Measurement; D017288:Pain Threshold / Q000187:drug effects*; D010149:Postoperative Pain / Q000188:drug therapy*; D049590:Postpartum Period / Q000187:drug effects*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000188:drug therapy; D012189:Retrospective Studies; D019966:Substance-Related Disorders / Q000150:complications / Q000534:rehabilitation
D000701:Analgesics, Opioid; D008691:Methadone; D005283:Fentanyl