M R Hoyt1, U Shah2, J Cooley3, M Temple4. 1. Anesthesiology Institute, Hillcrest Hospital, Cleveland Clinic Health System, 6870 Mayfield Road, Cleveland, OH 44124, United States. Electronic address: hoytm@ccf.org. 2. Department of Anesthesiology, Robert Wood Johnson University Hospital, 125 Paterson Street - CAB 3100, New Brunswick, NJ 08901, United States. 3. Department of Anesthesiology, University of Tennessee College of Medicine, Chandler Building, Suite 600, 877 Jefferson Avenue, Memphis, TN 38103, United States. 4. Department of Pharmacy, Hillcrest Hospital, Cleveland Clinic Health System, 6780 Mayfield Road, Cleveland, OH 44124, United States.
Abstract
OBJECTIVES: Management of labor analgesia and post-cesarean delivery pain is challenging in the patient taking buprenorphine as opioid addiction maintenance therapy. We observed whether substituting clonidine for fentanyl in an epidural solution would provide adequate analgesia for labor and after cesarean delivery. METHODS: We substituted our standard 2 µg/mL fentanyl in 0.0625% bupivacaine epidural solution with 2 µg/mL clonidine in 0.0625% bupivacaine, or 1.2 µg/mL clonidine in 0.1% bupivacaine, for labor and post-cesarean analgesia in parturients on buprenorphine therapy. All cesarean deliveries were performed with a combined spinal-epidural technique and the catheters maintained for immediate postoperative analgesia using an epidural infusion. Catheters were discontinued the next day and patients were then managed with other analgesics based on obstetric preference. We recorded pain scores during labor and in the immediate post-surgical period; and supplemental medications given after epidural catheter removal. RESULTS: Fourteen patients were included in the study, of whom seven presented in spontaneous labor and seven had elective cesarean delivery. All laboring patients achieved good analgesia, and five of seven avoided supplemental opioid use in the postpartum phase. Of the postsurgical patients, six of seven had pain scores less than 5/10 at epidural catheter removal and three of seven avoided supplemental opioids postoperatively. CONCLUSIONS: The combination of clonidine and bupivacaine appears effective in parturients on buprenorphine therapy for opioid addiction maintenance. As study numbers were small and several factors were not examined, further confirmatory research is needed, including to determine the ideal dose of epidural clonidine in this setting.
OBJECTIVES: Management of labor analgesia and post-cesarean delivery pain is challenging in the patient taking buprenorphine as opioid addiction maintenance therapy. We observed whether substituting clonidine for fentanyl in an epidural solution would provide adequate analgesia for labor and after cesarean delivery. METHODS: We substituted our standard 2 µg/mL fentanyl in 0.0625% bupivacaine epidural solution with 2 µg/mL clonidine in 0.0625% bupivacaine, or 1.2 µg/mL clonidine in 0.1% bupivacaine, for labor and post-cesarean analgesia in parturients on buprenorphine therapy. All cesarean deliveries were performed with a combined spinal-epidural technique and the catheters maintained for immediate postoperative analgesia using an epidural infusion. Catheters were discontinued the next day and patients were then managed with other analgesics based on obstetric preference. We recorded pain scores during labor and in the immediate post-surgical period; and supplemental medications given after epidural catheter removal. RESULTS: Fourteen patients were included in the study, of whom seven presented in spontaneous labor and seven had elective cesarean delivery. All laboring patients achieved good analgesia, and five of seven avoided supplemental opioid use in the postpartum phase. Of the postsurgical patients, six of seven had pain scores less than 5/10 at epidural catheter removal and three of seven avoided supplemental opioids postoperatively. CONCLUSIONS: The combination of clonidine and bupivacaine appears effective in parturients on buprenorphine therapy for opioid addiction maintenance. As study numbers were small and several factors were not examined, further confirmatory research is needed, including to determine the ideal dose of epidural clonidine in this setting.
Authors: Emery R Eaves; Jarrett Barber; Ryann Whealy; Sara A Clancey; Rita Wright; Jill Hager Cocking; Joseph Spadafino; Crystal M Hepp Journal: PLoS One Date: 2021-06-03 Impact factor: 3.752
Authors: Mellany A Stanislaus; Joseph L Reno; Robert H Small; Julie H Coffman; Mona Prasad; Avery M Meyer; Kristen M Carpenter; John C Coffman Journal: J Pain Res Date: 2020-04-28 Impact factor: 3.133
Authors: Joseph L Reno; Michael Kushelev; Julie H Coffman; Mona R Prasad; Avery M Meyer; Kristen M Carpenter; Marilly S Palettas; John C Coffman Journal: J Pain Res Date: 2020-12-30 Impact factor: 3.133