title: Marked variability in peri-partum anesthetic management of patients on buprenorphine maintenance therapy (BMT): can there be an underlying acute opioid induced hyperalgesia precipitated by neuraxial opioids in BMT patients?
abstract: OBJECTIVE
  To compare adequacy of peri-partum pain management with or without neuraxial opioids in patients on buprenorphine maintenance therapy (BMT).
  
  
  METHODS
  After institutional review board approval for the study protocol, retrospective peripartum anesthesia/analgesia data of BMT patients for five-year period were accessed and analyzed.
  
  
  RESULTS
  Out of reviewed 51 patient charts, nineteen patients were found eligible for final comparative analysis. The daily amounts of peri-partum rescue analgesics with vs without neuraxial opioids were equianalgesic doses of parenteral hydromorphone (10.7 +/- 13.8 mg vs 2.6 +/- 0.7 mg, P = 0.45 for vaginal delivery; 16.4 +/- 21.1 mg vs 5.3 +/- 3.6 mg, P = 0.42 for elective cesarean section (CS)), oral ibuprofen (1.1 +/- 0.5g vs 0.8 +/- 0.4g, P = 0.37 for vaginal delivery; 1.1 +/- 0.2g vs 1.6 +/- 0.6g, P = 0.29 for elective CS), and acetaminophen (0.2 +/- 0.4g vs 0 +/- 0g, P = 0.56 for vaginal delivery; 0.3 +/- 0.3g vs 0.2 +/- 0.2g, P = 0.81 for elective CS). In the patients who underwent emergent CS after failed labor (all had received epidural opioids), there was clinical trend for higher daily amounts ofperi-partum rescue analgesics (parenteral hydromorphone 35.6 +/- 37.5 mg; oral ibuprofen 1.2 +/- 0.4g; oral acetaminophen 1.2 +/- 0.5g), when compared with vaginal delivery patients or elective CS patients who all had received neuraxial opioids.
  
  
  CONCLUSIONS
  As the study was underpowered (n = 19), future adequately powered studies are required to conclude for-or-against the use ofneuraxial opioids in BMT patients; and pro-nociceptive activation by neuraxial opioids may be worth investigating to improve our understanding of peripartum pain management of BMT patients.
authors.forename: Deepak
authors.initials: D
authors.lastname: Gupta
authors.forename: Carl
authors.initials: C
authors.lastname: Christensen
authors.forename: Vitaly
authors.initials: V
authors.lastname: Soskin
mesh_terms: D000082:Acetaminophen / Q000008:administration & dosage; D000293:Adolescent; D000328:Adult; D016362:Analgesia, Obstetrical / Q000009:adverse effects / Q000379:methods*; D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000009:adverse effects; D002047:Buprenorphine / Q000008:administration & dosage*; D002585:Cesarean Section / Q000379:methods; D036861:Delivery, Obstetric / Q000379:methods; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D004091:Hydromorphone / Q000009:adverse effects; D006930:Hyperalgesia / Q000139:chemically induced; D007052:Ibuprofen / Q000008:administration & dosage; D058850:Opiate Substitution Treatment / Q000379:methods; D009293:Opioid-Related Disorders / Q000534:rehabilitation; D011247:Pregnancy; D011248:Pregnancy Complications / Q000534:rehabilitation*; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid; D000082:Acetaminophen; D002047:Buprenorphine; D004091:Hydromorphone; D007052:Ibuprofen