A Systematic Scoping Review of Peridelivery Pain Management for Pregnant People With Opioid Use Disorder: From the Society for Obstetric Anesthesia and Perinatology and Society for Maternal Fetal Medicine.
Journal
Anesthesia and analgesia
ISSN: 1526-7598
Titre abrégé: Anesth Analg
Pays: United States
ID NLM: 1310650
Informations de publication
Date de publication:
01 11 2022
01 11 2022
Historique:
pubmed:
23
9
2022
medline:
26
10
2022
entrez:
22
9
2022
Statut:
ppublish
Résumé
The prevalence of pregnant people with opioid use disorder (OUD), including those receiving medications for opioid use disorder (MOUD), is increasing. Challenges associated with pain management in people with OUD include tolerance, opioid-induced hyperalgesia, and risk for return to use. Yet, there are few evidence-based recommendations for pain management in the setting of pregnancy and the postpartum period, and many peripartum pain management studies exclude people with OUD. This scoping review summarized the available literature on peridelivery pain management in people with OUD, methodologies used, and identified specific areas of knowledge gaps. PubMed and Embase were comprehensively searched for publications in all languages on peripartum pain management among people with OUD, both treated with MOUD and untreated. Potential articles were screened by title, abstract, and full text. Data abstracted were descriptively analyzed to map available evidence and identify areas of limited or no evidence. A total of 994 publications were imported for screening on title, abstracts, and full text, yielding 84 publications identified for full review: 32 (38.1%) review articles, 14 (16.7%) retrospective studies, and 8 (9.5%) case reports. There were 5 randomized controlled trials. Most studies (64%) were published in perinatology (32; 38.1%) journals or anesthesiology (22; 26.2%) journals. Specific areas lacking trial or systematic review evidence include: (1) methods to optimize psychological and psychosocial comorbidities relevant to acute pain management around delivery; (2) alternative nonopioid and nonpharmacologic analgesia methods; (3) whether or not to use opioids for severe breakthrough pain and how best to prescribe and monitor its use after discharge; (4) monitoring for respiratory depression and sedation with coadministration of other analgesics; (5) optimal neuraxial analgesia dosing and adjuncts; and (6) benefits of abdominal wall blocks after cesarean delivery. No publications discussed naloxone coprescribing in the labor and delivery setting. We observed an increasing number of publications on peripartum pain management in pregnant people with OUD. However, existing published works are low on the pyramid of evidence (reviews, opinions, and retrospective studies), with a paucity of original research articles (<6%). Opinions are conflicting on the utility and disutility of various analgesic interventions. Studies generating high-quality evidence on this topic are needed to inform care for pregnant people with OUD. Specific research areas are identified, including utility and disutility of short-term opioid use for postpartum pain management, role of continuous wound infiltration and truncal nerve blocks, nonpharmacologic analgesia options, and the best methods to support psychosocial aspects of pain management.
Identifiants
pubmed: 36135926
doi: 10.1213/ANE.0000000000006167
pii: 00000539-202211000-00005
pmc: PMC9588509
mid: NIHMS1817945
doi:
Substances chimiques
Analgesics, Opioid
0
Analgesics
0
Naloxone
36B82AMQ7N
Types de publication
Systematic Review
Journal Article
Research Support, Non-U.S. Gov't
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
912-925Subventions
Organisme : NICHD NIH HHS
ID : K12 HD043441
Pays : United States
Organisme : NIDA NIH HHS
ID : K23 DA047476
Pays : United States
Informations de copyright
Copyright © 2022 International Anesthesia Research Society.
Déclaration de conflit d'intérêts
The authors declare no conflicts of interest.
Références
ACOG. Committee Opinion 711: opioid use and opioid use disorder in pregnancy. Obstet Gynecol. 2017;130:e81–e94.
Kehlet H, Jensen TS, Woolf CJ. Persistent postsurgical pain: risk factors and prevention. Lancet. 2006;367:1618–1625.
Xiong PT, Poehlmann J, Stowe Z, Antony KM. Anxiety, depression, and pain in the perinatal period: a review for obstetric care providers. Obstet Gynecol Surv. 2021;76:692–713.
Jones HE, Fischer G, Heil SH, et al. Maternal opioid treatment: human experimental research (MOTHER)–approach, issues and lessons learned. Addiction. 2012;107(suppl 1):28–35.
Souzdalnitski D, Snegovskikh D. Analgesia for the parturient with chronic nonmalignant pain. Tech Reg Anesth Pain Manag. 2014;18:166–171.
Tricco AC, Lillie E, Zarin W, et al. PRISMA Extension for Scoping Reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med. 2018;169:467–473.
Bramer WM, Giustini D, de Jonge GB, Holland L, Bekhuis T. De-duplication of database search results for systematic reviews in EndNote. J Med Libr Assoc. 2016;104:240–243.
Jones HE, Martin PR, Heil SH, et al. Treatment of opioid-dependent pregnant women: clinical and research issues. J Subst Abuse Treat. 2008;35:245–259.
Kork F, Kleinwachter R, Kaufner L, Weiss-Gerlach E, Siedentopf JP, Spies C. Women in labor who consume substances: significance in obstetric anesthesia. Anesthesiology Intensive Med Emergency Med Pain Ther. 2011;46:640–646.
Martin CE, Terplan M, Krans EE. Pain, opioids, and pregnancy: historical context and medical management. Clin Perinatol. 2019;46:833–847.
Park EM, Meltzer-Brody S, Suzuki J. Evaluation and management of opioid dependence in pregnancy. Psychosomatics. 2012;53:424–432.
Eyler EC. Chronic and acute pain and pain management for patients in methadone maintenance treatment. Am J Addict. 2013;22:75–83.
Ordean A, Kahan M, Graves L, Abrahamans R, Boyahian T. Integrated care for pregnant women on methadone maintenance treatment. Can Fam Physician. 2013;59:e462–e469.
Smith MV, Costello D, Yonkers KA. Clinical correlates of prescription opioid analgesic use in pregnancy. Matern Child Health J. 2015;19:548–556.
Towers CV, Katz E, Liske E, Hennessy M, Wolfe L, Visconti K. Psychosocial background history of pregnant women with opioid use disorder: a prospective cohort study. Am J Perinatol. 2020;37:924–928.
Cengiz H, Dagdeviren H, Karaahmet O, Kaya C, Yildiz S, Ekin M. Maternal and neonatal effects of substance abuse during pregnancy: a case report. The Medical Bulletin of Haseki. 2013;51:76–78.
Gomar C, Luis M, Nalda MA. Sacro-iliitis in a heroin addict. A contra-indication to spinal anaesthesia. Anaesthesia. 1984;39:167–170.
Jones HE, Deppen K, Hudak ML, et al. Clinical care for opioid-using pregnant and postpartum women: the role of obstetric providers. Am J Obstet Gynecol. 2014;210:302–310.
Höflich AS, Langer M, Jagsch R, et al. Peripartum pain management in opioid dependent women. Eur J Pain. 2012;16:574–584.
Birnbach DJ, Browne IM, Kim A, Stein DJ, Thys DM. Identification of polysubstance abuse in the parturient. Br J Anaesth. 2001;87:488–490.
McCalla S, Feldman J, Webbeh H, Ahmadi R, Minkoff HL. Changes in perinatal cocaine use in an inner-city hospital, 1988 to 1992. Am J Public Health. 1995;85:1695–1697.
Robertson JL, McGrady EM, Young S. Drug-using parturients in a tertiary referral centre 11AP4-9. Eur J Anesth. 2011;166.
Schulman M, Morel M, Karmen A, Chazotte C. Perinatal screening for drugs of abuse: reassessment of current practice in a high-risk area. Am J Perinatol. 1993;10:374–377.
Tabi S, Heitner SA, Shivale S, Minchenberg S, Faraone SV, Johnson B. Opioid addiction/pregnancy and neonatal abstinence syndrome (NAS): a preliminary open-label study of buprenorphine maintenance and drug use targeted psychotherapy (DUST) on cessation of addictive drug use. Front Psychiatry. 2020;11:563409.
Wong S, Ordean A, Kahan M; Society of Obstetricians and Gynecologists of Canada. SOGC clinical practice guidelines: substance use in pregnancy: No. 256, April 2011. Int J Gynaecol Obstet. 2011;114:190–202.
Soens MA, He J, Bateman BT. Anesthesia considerations and post-operative pain management in pregnant women with chronic opioid use. Semin Perinatol. 2019;43:149–161.
Wilder CM, Winhusen T. Pharmacological management of opioid use disorder in pregnant women. CNS Drugs. 2015;29:625–636.
Cassidy B, Cyna AM. Challenges that opioid-dependent women present to the obstetric anaesthetist. Anaesth Intensive Care. 2004;32:494–501.
Wiegand S, Stringer E, Seashore C, et al. 750: Buprenorphine/naloxone (B/N) and methadone (M) maintenance during pregnancy: a chart review and comparison of maternal and neonatal outcomes. Am J Obstet Gynecol. 2014;210:S368–S9.
Ecker J, Abuhamad A, Hill W, et al. Substance use disorders in pregnancy: clinical, ethical, and research imperatives of the opioid epidemic: a report of a joint workshop of the Society for Maternal-Fetal Medicine, American College of Obstetricians and Gynecologists, and American Society of Addiction Medicine. Am J Obstet Gynecol. 2019;221:B5–B28.
Reddi D, Mehta A, Patel N, Brandner B. Perioperative pain management for cesarean section in the mother with severe acute on chronic pain and opioid dependence. Eur J Anaesthesiol. 2013;30:178.
Brown HL. Opioid management in pregnancy and postpartum. Obstet Gynecol Clin North Am. 2020;47:421–427.
Faitot V, Simonpoli A, Keita H. [Anaesthetic and analgesic considerations in drug abusing pregnant women]. Ann Fr Anesth Reanim. 2009;28:609–614.
Fultz JM, Senay EC. Guidelines for the management of hospitalized narcotics addicts. Ann Intern Med. 1975;82:815–818.
Goff M, O’Connor M. Perinatal care of women maintained on methadone. J Midwifery Womens Health. 2007;52:e23–e26.
Gopman S. Prenatal and postpartum care of women with substance use disorders. Obstet Gynecol Clin North Am. 2014;41:213–228.
Jones HE, Finnegan LP, Kaltenbach K. Methadone and buprenorphine for the management of opioid dependence in pregnancy. Drugs. 2012;72:747–757.
Klaman SL, Isaacs K, Leopold A, et al. Treating women who are pregnant and parenting for opioid use disorder and the concurrent care of their infants and children: literature review to Support National Guidance. J Addict Med. 2017;11:178–190.
Ludlow JP, Evans SF, Hulse G. Obstetric and perinatal outcomes in pregnancies associated with illicit substance abuse. Aust N Z J Obstet Gynaecol. 2004;44:302–306.
Lugo RA, Satterfield KL, Kern SE. Pharmacokinetics of methadone. J Pain Palliat Care Pharmacother. 2005;19:13–24.
Mahoney K, Reich W, Urbanek S. Substance use disorder: prenatal, intrapartum, and postpartum care. Am J Matern Child Nurs. 2019;44:284–288.
Mozurkewich EL, Rayburn WF. Buprenorphine and methadone for opioid addiction during pregnancy. Obstet Gynecol Clin North Am. 2014;41:241–253.
Pan A, Zakowski M. Peripartum anesthetic management of the opioid-tolerant or buprenorphine/suboxone-dependent patient. Clin Obstet Gynecol. 2017;60:447–458.
Pritham UA, McKay L. Safe management of chronic pain in pregnancy in an era of opioid misuse and abuse. J Obstet Gynecol Neonatal Nurs. 2014;43:554–567.
Raymond BL, Kook BT, Richardson MG. The opioid epidemic and pregnancy: implications for anesthetic care. Curr Opin Anaesthesiol. 2018;31:243–250.
Sen S, Arulkumar S, Cornett EM, et al. New pain management options for the surgical patient on methadone and buprenorphine. Curr Pain Headache Rep. 2016;20:16.
Tran TH, Griffin BL, Stone RH, Vest KM, Todd TJ. Methadone, buprenorphine, and naltrexone for the treatment of opioid use disorder in pregnant women. Pharmacotherapy. 2017;37:824–839.
Young JL, Lockhart EM, Baysinger CL. Anesthetic and obstetric management of the opioid-dependent parturient. Int Anesthesiol Clin. 2014;52:67–85.
Jones HE, O’Grady K, Dahne J, et al. Management of acute postpartum pain in patients maintained on methadone or buprenorphine during pregnancy. Am J Drug Alcohol Abuse. 2009;35:151–156.
McNicholas LF, Holbrook AM, O’Grady KE, et al. Effect of hepatitis C virus status on liver enzymes in opioid-dependent pregnant women maintained on opioid-agonist medication. Addiction. 2012;107(suppl 1):91–97.
Ko JY, Tong VT, Haight SC, Terplan M, Snead C, Schulkin J. Obstetrician-gynecologists’ practice patterns related to opioid use during pregnancy and postpartum-United States, 2017. J Perinatol. 2020;40:412–421.
Meyer M, Wagner K, Benvenuto A, Plante D, Howard D. Intrapartum and postpartum analgesia for women maintained on methadone during pregnancy. Obstet Gynecol. 2007;110:261–266.
Wendling AL, Garvan C, Roussos-Ross D, Zhang L, Zeng D. Pain outcomes among patients after cesarean consuming buprenorphine or methadone and opioid-naïve patients. J Clin Anesth. 2020;65:109905.
Harter K. Opioid use disorder in pregnancy. Ment Health Clin. 2019;9:359–372.
Kliman L. Drug dependence and pregnancy: antenatal and intrapartum problems. Anaesth Intensive Care. 1990;18:358–360.
Jones CW, Terplan M. Pregnancy and naltrexone pharmacotherapy. Obstet Gynecol. 2018;132:923–925.
Jones HE, Heil SH, Baewert A, et al. Buprenorphine treatment of opioid-dependent pregnant women: a comprehensive review. Addiction. 2012;107(suppl 1):5–27.
Safley RR, Swietlikowski J. Pain management in the opioid-dependent pregnant woman. J Perinat Neonatal Nurs. 2017;31:118–125.
Stanhope TJ, Gill LA, Rose C. Chronic opioid use during pregnancy: maternal and fetal implications. Clin Perinatol. 2013;40:337–350.
Landau R. Post-cesarean delivery pain. Management of the opioid-dependent patient before, during and after cesarean delivery. Int J Obstet Anesth. 2019;39:105–116.
Ludlow J, Christmas T, Paech MJ, Orr B. Drug abuse and dependency during pregnancy: anaesthetic issues. Anaesth Intensive Care. 2007;35:881–893.
Krans EE, Bobby S, England M, et al. The pregnancy recovery center: a women-centered treatment program for pregnant and postpa rtum women with opioid use disorder. Addict Behav. 2018;86:124–129.
Tith S, Bining G, Bollag LA. Management of eight labor and delivery patients dependent on buprenorphine (subutex): a retrospective chart review. F1000Research. 2019:1–11.
Leighton BL, Crock LW. Case series of successful postoperative pain management in buprenorphine maintenance therapy patients. Anesth Analg. 2017;125:1779–1783.
Meyer M, Paranya G, Keefer Norris A, Howard D. Intrapartum and postpartum analgesia for women maintained on buprenorphine during pregnancy. Eur J Pain. 2010;14:939–943.
Mittal L, Suzuki J. Feasibility of collaborative care treatment of opioid use disorders with buprenorphine during pregnancy. Subst Abus. 2017;38:261–264.
Kuczkowski KM. The effects of drug abuse on pregnancy. Curr Opin Obstet Gynecol. 2007;19:578–585.
Wolman I, Niv D, Yovel I, Pausner D, Geller E, David MP. Opioid-addicted parturient, labor, and outcome: a reappraisal. Obstet Gynecol Surv. 1989;44:592–597.
Sander SC, Hays LR. Prescription opioid dependence and treatment with methadone in pregnancy. J Opioid Manag. 2005;1:91–97.
Ellis JD, Cairncross M, Struble CA, Carr MM, Ledgerwood DM, Lundahl LH. Correlates of treatment retention and opioid misuse among postpartum women in methadone treatment. J Addict Med. 2019;13:153–158.
Thakrar S, Lee J, Martin CE, Butterworth Iv J. Buprenorphine management: a conundrum for the anesthesiologist and beyond—a one-act play. Reg Anesth Pain Med. 2020;45:656–659.
Gupta D, Christensen C, Soskin V. 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? Middle East J Anaesthesiol. 2013;22:273–281.
Martin CS, McGrady EM, Colquhoun A, Thorburn J. Extradural methadone and bupivacaine in labour. Br J Anaesth. 1990;65:330–332.
Hoyt MR, Shah U, Cooley J, Temple M. Use of epidural clonidine for the management of analgesia in the opioid addicted parturient on buprenorphine maintenance therapy: an observational study. Int J Obstet Anesth. 2018;34:67–72.
Silver H, Wapner R, Rattan P, Loriz-Vega M, Finnegan LP. Drug dependence in pregnancy: intrapartum course and management. NIDA Res Monogr. 1986;67:300–306.
Migliaccio L, Lawton R, Leeman L, Holbrook A. Initiating intrapartum nitrous oxide in an academic hospital: considerations and challenges. J Midwifery Womens Health. 2017;62:358–362.
Shainker SA, Saia K, Lee-Parritz A. Opioid addiction in pregnancy. Obstet Gynecol Surv. 2012;67:817–825.
Parad R, McBride C, Garofalo F, Meyer M. 472: equivalent post-cesarean pain and analgesic requirements in women maintained on methadone versus buprenorphine during pregnancy. Am J Obstet Gynecol. 2020;222:S309.
Vilkins AL, Bagley SM, Hahn KA, et al. Comparison of post-cesarean section opioid analgesic requirements in women with opioid use disorder treated with methadone or buprenorphine. J Addict Med. 2017;11:397–401.
Jones HE, Johnson RE, Milio L. Post-cesarean pain management of patients maintained on methadone or buprenorphine. Am J Addict. 2006;15:258–259.
Duzyj CM, Simonds A, Jones I, Hill JM, Khan S, Parrott JS. 281: transcutaneous electrical nerve stimulation to reduce pain and opioid use after cesarean: a pilot study. Am J Obstet Gynecol. 2020;222:S190.
Kunycky. Addiction and pregnancy: analysis of an intervention protocol for post-cesarean pain control. Obstet Gynecol. 2018;38C:40S.
Vilkins A, Wachman EM, Bagley SM, Saia K, Hahn KA, Alford DP. Comparison of post-cesarean opioid analgesic requirements in methadone and buprenorphine maintained women. Obstet Gynecol. 2016;127:107S.
Stanislaus MA, Reno JL, Small RH, et al. Continuous epidural hydromorphone infusion for post-cesarean delivery analgesia in a patient on methadone maintenance therapy: a case report. J Pain Res. 2020;13:837–842.
Wasiluk IM, Castillo D, Panni JK, Stewart S, Panni MK. Postpartum analgesia with dexmedetomidine in opioid tolerance during pregnancy. J Clin Anesth. 2011;23:593–594.
Pancaro C, Shah N, Pasma W, et al. Risk of major complications after perioperative norepinephrine infusion through peripheral intravenous lines in a multicenter study. Anesth Analg. 2020;131:1060–1065.
Birnbach DJ, Stein DJ. The substance-abusing parturient: implications for analgesia and anaesthesia management. Baillieres Clin Obstet Gynaecol. 1998;12:443–460.
Bollag L, Lim G, Sultan P, et al. Society for Obstetric Anesthesia and Perinatology: consensus statement and recommendations for enhanced recovery after cesarean. Anesth Analg. 2021;132:1362–1377.