Intrapartum and postpartum analgesia for women maintained on buprenorphine during pregnancy

Eur J Pain. 2010 Oct;14(9):939-43. doi: 10.1016/j.ejpain.2010.03.002. Epub 2010 May 4.

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.

Conclusion: 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.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Analgesics, Opioid / administration & dosage*
  • Buprenorphine / administration & dosage*
  • Cesarean Section / adverse effects
  • Cohort Studies
  • Female
  • Humans
  • Labor Pain / drug therapy*
  • Narcotic Antagonists / administration & dosage
  • Outcome Assessment, Health Care / methods
  • Pain, Postoperative / drug therapy
  • Postpartum Period / drug effects*
  • Pregnancy
  • Retrospective Studies
  • Young Adult

Substances

  • Analgesics, Opioid
  • Narcotic Antagonists
  • Buprenorphine