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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
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
Simon Ash Profile picture
Jun 10, 2023
Up next: @ValZaph moderates the #OBAnes session on PPH: a focus on coagulation. Dr Karine Doyon and @LorrainechowMD presenting. #CASAM2023 Image
PPH: a focus on coagulation is kicked off by Dr Karine Doyon (a hematologist). Objectives. Canada ranked 39th in world in maternal mortality - not sure if that’s good. We’re doing better than USA. #OBAnes #CASAM2023 ImageImageImage
Causes of coagulopathy in pregnancy - Dr Doyon won’t be discussing inherited disorders. The focus will be on the acquired hemorrhagic disorders. #OBAnes #CASAM2023 ImageImage
Read 20 tweets
Simon Ash Profile picture
Jun 10, 2023
@DrWesleyEdwards chair of @CAS_OBSection introduces the first #OBAnes session of #CASAM2023.
Speakers: @SusannaStanford @ammunro2 @Ropivacaine Image
@SusannaStanford starts off with the importance of having a talk with the word “failure” in it. #OBAnes #CASAM2023 ImageImage
I have not asked permission to share @SusannaStanford’s whole lecture video today, and it’s 20minutes long. However, see the following links:

oaawebcast.info/susanna

#OBAnes #CASAM2023
Read 29 tweets
Simon Ash Profile picture
Jun 4, 2023
Novel Content No.2 at #SOAPAM2023 virtual #OBAnes highlights Day 2: @DoctorStahl speaks on Obstetric Critical Care #OBCritCare ImageImage
@DoctorStahl is an intensive care bear, who loves #OBAnes. QR code to references. #OBCritCare #SOAPAM2023 ImageImageImage
Pregnancy-associated mortality ≈ maternal mortality. #OBAnes 0.2% - doing well (wonder what the denominator is?), so Elmo could ask why are we worried? #SOAPAM2023 ImageImageImage
Read 35 tweets

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