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Simon Ash Profile picture
@OBsleepmerchant
May 9, 2023 • 12 tweets • 13 min read • Read on X
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@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) Image
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 ImageImageImageImage
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 ImageImageImageImage
US system has unique barriers to MAT. Buprenorphine may be superior to methadone. #OBAnes #SOAPAM2023 ImageImageImage
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… ImageImageImageImage
@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… Image
@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… ImageImageImage
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… ImageImage
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… ImageImage
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… ImageImageImageImage
Summary from @SparklesSpinals. #OBAnes #SOAPAM2023 ImageImage
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More from @OBsleepmerchant

Simon Ash Profile picture
May 9
@SQuashie presents an update on anesthesia for operative delivery. Declarations. Methodology and themes. #OAA24ASM #OBAnes

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Gastric USS. Oral rehydration has benefits over NPO wrt vasopressor use. #siptilsend safe, noting some patients have increased gastric volumes irrespective of starvation status. #OAA24ASM #OBAnes
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@SQuashie continues at a rapid pace. To DPE or not to DPE remains a question - 16min vs 19 min, is that 3 min clinically relevant? Esketamine for supplemental analgesia - >95% had psych effects, read @rjharrison79 editorial. #OAA24ASM #OBAnes
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Read 16 tweets
Simon Ash Profile picture
May 9
@Jamesocarroll presents an Update on Labour and Delivery. Disclosures #OAA24ASM #OBAnes

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How the lecture was put together. Screening. Themes. How to interpret the slides. Very Ostheimer-esque @Jamesocarroll #OAA24ASM #OBAnes


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@Jamesocarroll Clinical practice theme: intrathecal catheters & ADP. Intrathecal catheters: No decrease in PDPH, but reduction in EBP. 10mL intrathecal saline decreased PDPH & need for EBP. Of note, the percentage of epidurals requiring multiple attempts. #OAA24ASM #OBAnes

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Read 17 tweets
Simon Ash Profile picture
May 5
8am-ish in Denver and time for a much anticipated session: PDPH beyond the guidelines. Moderated by Dr Lisa Leffert, featuring @Ropivacaine, @euklaas, @sharonOzynger and @WouterSchievink at #SOAPAM2024 #OBAnes

(HT: @Ropivacaine, bless his heart, he knows I hate missing out)

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Hot off the Press? August 2023! @JAMANetworkOpen with quite an illustrious team including @Ropivacaine @robin_russell1 @KalagaraHari @LimGrapes @claralexlobo @noolslucas @NarouzeMD (please tag others if you have their handles?) #SOAPAM2024 #OBAnes

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Introduction, Methods and the 10 questions. #SOAPAM2024 #OBAnes

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Read 11 tweets
Simon Ash Profile picture
Jun 12, 2023
Next up at #CASAM2023 - fittingly keeping the most important academic session to last: #OBAnes
@ValZaph moderating the Maternal Experience and Outcomes: Improving the care we provide. @DrWesleyEdwards

Bookends the 1st #OBAnes session, on intrapartum pain at cesarean section… twitter.com/i/web/status/1… Image
Dr Christina Lamontagne kicks off the session with: Use of Dexmedetomidine in improving maternal experience and outcomes. Nothing to disclose. Then an important disclosure: All indications discussed are OFF LABEL in Canada. Objectives.
#OBAnes #CASAM2023 ImageImageImageImage
Why does Dr Lamontagne use a lot of dexmedetomidine (not only in #OBAnes mind)? Clinical pharmacology of dexmedetomidine (1): highly selective alpha-2 agonist; sedation WITHOUT amnesia at locus coeruleus. #CASAM2023 ImageImageImage
Read 9 tweets
Simon Ash Profile picture
Jun 11, 2023
Dr Ning Nan Wang introduces @harshamd5 to open the chronic pain session: Perioperative use of opioid in the context of Opioid Epidemic. #CASAM2023 ImageImageImage
The opioid crisis isn’t new - China probably remembers the Opium wars that helped establish a British foothold on the continent. Opioids and OUR crisis. Is what we fear the real crisis? Are opioid-related deaths due to surgical prescriptions? No, mostly due to street fentanyl.… twitter.com/i/web/status/1… ImageImageImage
Opioid use around the time of surgery. Understanding nociception vs pain. Does eliminating opioids during surgery make a difference - no definitive conclusions. #CASAM2023 ImageImageImage
Read 11 tweets
Simon Ash Profile picture
Jun 10, 2023
@DrLucieFilteau introduces @CMA_Docs president @AlikaMD for his keynote address at #CASAM2023 Image
@AlikaMD starts with the state of the 🇨🇦 health system, including a little history. #CASAM2023 ImageImage
The 🇨🇦 health system approach to problems, creating new problems as a result with a dangerous lack of interoperability. #CASAM2023 ImageImageImage
Read 12 tweets

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