title: Intrapartum and postpartum analgesia for women maintained on buprenorphine during pregnancy.
abstract: 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.
authors.affiliation: Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Burlington, VT, USA. marjorie.meyer@uvm.edu
authors.forename: Marjorie
authors.initials: M
authors.lastname: Meyer
authors.forename: Gretchen
authors.initials: G
authors.lastname: Paranya
authors.forename: Ananda
authors.initials: A
authors.lastname: Keefer Norris
authors.forename: Diantha
authors.initials: D
authors.lastname: Howard
mesh_terms: 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
chemical_list: D000701:Analgesics, Opioid; D009292:Narcotic Antagonists; D002047:Buprenorphine