Intrapartum and Postpartum Analgesia for Women Maintained on Methadone During Pregnancy

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.
Obstetrics and Gynecology (Impact Factor: 5.18). 09/2007; 110(2 Pt 1):261-6. DOI: 10.1097/01.AOG.0000275288.47258.e0
Source: PubMed


To determine whether methadone maintenance alters intrapartum or postpartum pain or medication requirements.
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.
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.
Methadone-maintained women have similar analgesic needs and response during labor, but require 70% more opiate analgesic after cesarean delivery.

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    • "Or les prescripteurs sont encore peu familiarisés à cette démarche. Ainsi, une étude autrichienne, menée en double aveugle, [18] a récemment démontré qu'après une césarienne, les femmes recevant un TSO avaient moins accès aux traitements antalgiques opioïdes alors qu'il est démontré qu'elles en ont davantage besoin [19]. La réticence des soignants vis-à-vis des traitements opioïdes a parfois été qualifiée d'« opiophobie » par certains auteurs [20]. "
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    ABSTRACT: Opioid maintenance treatments (OMT) reduce illicit opiate use and its associated risks. They are often prescribed on a long-term basis. Physiological changes induced by long-term OMT may cause hyperalgesia and cross-tolerance to opioid agonists, which suggests that the dosage of analgesic treatment should be modified in cases of acute pain, especially when an opioid-based analgesia is required. When treatment with analgesics is necessary, OMT must be maintained, except in exceptional cases. If a split-dosing schedule is temporarily employed during OMT, the daily dosage should not be increased for analgesic purposes. Analgesic treatment must be managed differently in case of treatment with buprenorphine or methadone. With buprenorphine, non-opioid analgesics should be introduced first, if possible. If this strategy is inefficient or contraindicated, a temporary or definitive switch to methadone should be considered. In the case of methadone-based OMT, opioid analgesics should be added directly and the dosage should be adapted according to the level of pain reported by the patient.
    Full-text · Article · Mar 2013 · La Presse Médicale
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    • "Moreover , opioid dependent patients in methadone maintenance therapy seem to be more sensitive to pain than those opioid dependent patients maintained on buprenorphine (Compton et al., 2001). This experimental data is reflected by clinical investigations examining differences in pain management between opioid-dependent and non-opioid dependent pregnant women thus revealing higher pain scores and higher requirement of analgesics in the opioid dependent group in the postpartum period (Meyer et al., 2010, 2007). The analysis of the influence of the applied maintenance drug on postpartum pain revealed adequate pain control both in buprenorphine and methadone maintained women with standard treatment options, with drug-specific differences in the time course of the reduction of NSAIDs in the immediate postpartum period (Jones et al., 2006, 2009). "
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