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


METHODS
Sixty three patients treated with buprenorphine for opioid dependence during pregnancy (vaginal n = 44; cesarean n = 19) were matched retrospectively to control women. Analgesic medication and pain scores (0-10) were extracted from the medical record. Primary endpoint: opioid utilization postpartum (oxycodone equivalents). Secondary endpoints: pain scores and intrapartum analgesia.


RESULTS
There were no differences in intrapartum pain or analgesia. Following vaginal birth, buprenorphine maintained women had increased pain (buprenorphine 2.7 (1.7,4.0); control 2.1 (1.2,3.0), p = 0.006) but no increase in opioid utilization (buprenorphine: 11.8 ± 24.8; control 5.4 ± 10.4 mg/24 h, p = 0.10); following cesarean delivery both pain (buprenorphine: 5.1 (4.1,6.1); control: 3.3 (2.5,4.1), p = 0.009) and opioid utilization (buprenorphine: 89.3 ± 38.0, control: 60.9 ± 13.1 mg/24 h, p = 0.004) were increased.


CONCLUSIONS
Buprenorphine maintained women have similar intrapartum pain and analgesic needs during labor, but experience more postpartum pain and require 47% more opioid analgesic following cesarean delivery.
Meyer
Marjorie
M
Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Burlington, VT, USA. marjorie.meyer@uvm.edu
Paranya
Gretchen
G
Keefer Norris
Ananda
A
Howard
Diantha
D
D000328:Adult; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D002047:Buprenorphine / Q000008:administration & dosage*; D002585:Cesarean Section / Q000009:adverse effects; D015331:Cohort Studies; D005260:Female; D006801:Humans; D048949:Labor Pain / Q000188:drug therapy*; D009292:Narcotic Antagonists / Q000008:administration & dosage; D017063:Outcome Assessment, Health Care / Q000379:methods; D010149:Postoperative Pain / Q000188:drug therapy; D049590:Postpartum Period / Q000187:drug effects*; D011247:Pregnancy; D012189:Retrospective Studies; D055815:Young Adult
D000701:Analgesics, Opioid; D009292:Narcotic Antagonists; D002047:Buprenorphine