Resident Review  |   February 2018
How Obstetric Anesthesiologists Can Respond to the Opioid Epidemic
Article Information
Education / CPD / Obstetric Anesthesia / Pain Medicine / Resident Review
Resident Review   |   February 2018
How Obstetric Anesthesiologists Can Respond to the Opioid Epidemic
ASA Monitor 02 2018, Vol.82, 72-73.
ASA Monitor 02 2018, Vol.82, 72-73.
“Epidural in room 19,” my attending told me. As I went through the patient’s history, she informed me that she had a history of opioid dependence and was being maintained on Suboxone® (buprenorphine and naloxone) during her pregnancy. I explained the risks of epidural anesthesia along with the formulation of the epidural infusion (bupivacaine and fentanyl mix). She then followed with a question that had me perplexed, “Will the fentanyl dose in the epidural infusion cause me to relapse?”
The prevalence of opioid abuse during pregnancy has more than doubled over the past 20 years. Parturients who struggle with opioid abuse or dependence are at increased odds of maternal death, placental abruption, increased length of hospital stay, oligohydramnios and overall blood product transfusions. Other negative outcomes included stillbirth, intrauterine growth restriction, premature rupture of membranes, preterm labor and cesarean deliveries.1  With the opioid epidemic worsening and increasing in this patient population, our job as anesthesiologists during labor and delivery becomes even more central amidst the current opioid epidemic. As anesthesiologists, can we (and should we) avoid commonly used narcotics associated with high abuse potential? Can our pharmacologic regimen be altered in high-risk population groups such as obstetric patients? In order to answer these questions, we need to re-examine the effects of narcotic abuse and how this may affect our delivery of anesthesia.
1 Comment
February 3, 2018
Pamela Flood
Stanford University
Another adjuvant

It is not clear whether a single remote exposure to an opioid increases risk of relapse. The perception is enough to merit concern. There are non-opioid adjuvants, including clonidine and epinephrine, that allow for the reduction of local anesthetic concentration and reduced motor block in a labor epidural.

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