@SparklesSpinals presents on Opioids and Pregnancy: Current & Future practice at #SOAPAM2023.
(Thanks to @SparklesSpinals for assisting me with an updated slide deck, and apologies for delay tweeting)
On the agenda, intrapartum and postpartum opioid use. 20% parturient fill an opioid script DURING pregnancy, 95% for acute or chronic pain. Opioid use in pregnancy has maternal AND fetal effects. #OBAnes #SOAPAM2023
What about supervised detox? Relapse rates during pregnancy = HIGH! MAT: medication assisted treatment for parturients with OUD. Methadone & Buprenorphine. Remember tailor opioid treatments with similar Mu affinity. #OBAnes #SOAPAM2023
US system has unique barriers to MAT. Buprenorphine may be superior to methadone. #OBAnes #SOAPAM2023
Moving postpartum on the agenda. Cesarean section is associated with chronic pain: 10% incidence (4% severe, debilitating). @EJA_Journal review by Weibel et al. suggests may be as high as 1 in 5 at 3 months. @IJOA_Journal suggests 26,000 women yearly with persistent opioid use.… twitter.com/i/web/status/1…
@SparklesSpinals points out that the most common source of misused opioids is physician prescription (55%), mainly surgery-related. 10-15unused opioid tablets per person - almost 20 million excess opioid tablets prescribed per year. The 1 & 3 year probabilities of continued… twitter.com/i/web/status/1…
@acog suggests that future therapy be individualized. Individualized prescribing - where would we even start?
The development & validation of model to predict opioid use post-cesarean in @greenjrnl 2022 demonstrated opioid use in last 24 hrs as most important factor… twitter.com/i/web/status/1…
The same authors previously published published a RCT comparing a standard vs individualized oxycodone prescribing (@greenjrni 2018): patients use 60% of script, with analgesia accompanied by 50% reductions in opioid use / leftover drugs.
Importance of education cannot be… twitter.com/i/web/status/1…
Further future developments: intentional order sets. No standing PRN opioid orders (if requested, only 6 doses issued), discharge opioid amount based on inpatient use. Maximize multi modal use, have #OBAnes write orders.
Shared decision making as an intervention for parents… twitter.com/i/web/status/1…
Legislation. Effects of state law limiting opioid prescription: DECREASED number of patients with > 3 day duration of opioid therapy, median duration of therapy, and average opioid dose. No change in number of patients requiring additional prescription or visiting ED within 7… twitter.com/i/web/status/1…
Summary from @SparklesSpinals. #OBAnes #SOAPAM2023
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