阿片类药物使用障碍和慢性产前阿片类药物暴露患者中使用阿片类药物节约方案与产后疼痛感知。
Use of Opioid-Sparing Protocols and Perceived Postpartum Pain in Patients with Opioid Use Disorder and Chronic Prenatal Opioid Exposure.
机构信息
Department of Obstetrics and Gynecology, University of Michigan, 1540 East Hospital Drive SPC 4262, Ann Arbor, MI, 48109, USA.
University of Michigan, Program on Women's Healthcare Effectiveness Research, Ann Arbor, USA.
出版信息
Matern Child Health J. 2023 Aug;27(8):1416-1425. doi: 10.1007/s10995-023-03710-8. Epub 2023 Jun 2.
INTRODUCTION
Opioid-sparing protocols reduce postpartum opioid prescribing in opioid-naïve patients; however, patients with opioid use disorder (OUD) and complex pain needs who may benefit from these protocols are typically excluded from them. We assessed postpartum pain experiences of patients with OUD and chronic prenatal opioid exposure after implementation of an opioid-sparing protocol.
METHODS
A phone survey assessed postpartum pain experiences for people with chronic prenatal opioid exposure who delivered between January 2020 and August 2021 at an academic hospital. Analyses included descriptive statistics, qualitative content analysis, and a joint display comparing themes.
RESULTS
Of 25 patients, 18 (72%) participated; most were non-Hispanic White (100%, 18/18), publicly insured (78%, 14/18), multiparous (78%, 14/18), with OUD (100%, 18/18). No patients with a vaginal birth received an opioid prescription; half (4/8) with a cesarean birth received one at discharge. Over one-third (7/18, 39%) reported poor pain control (≥ 5/10) in the hospital and one week post-discharge; scores were higher for cesarean versus vaginal birth. Qualitative sub-analyses of open-ended responses revealed patient perceptions of postpartum pain and treatment. The most effective strategies, stratified by birth type and pain level, ranged from non-opioid medications for vaginal births and minor pain to prescription opioids for cesarean births and moderate-to-intense pain.
DISCUSSION
Postpartum opioid prescribing for patients with chronic prenatal opioid use was low for vaginal and cesarean birth following implementation of an opioid-sparing protocol. Patients with OUD reported good pain management with opioid-sparing pain regimens; however, many reported poorly controlled pain immediately postpartum. Future work should assess approaches to postpartum pain management that minimize the risks of opioid medication-particularly in at-risk groups.
简介
阿片类药物节约方案减少了阿片类药物初治患者产后阿片类药物的处方；然而，患有阿片类药物使用障碍（OUD）和复杂疼痛需求的患者通常被排除在这些方案之外。我们评估了实施阿片类药物节约方案后慢性产前阿片类药物暴露的 OUD 患者的产后疼痛体验。
方法
一项电话调查评估了 2020 年 1 月至 2021 年 8 月在一家学术医院分娩的慢性产前阿片类药物暴露患者的产后疼痛体验。分析包括描述性统计、定性内容分析和比较主题的联合展示。
结果
25 名患者中，18 名（72%）参与了研究；大多数为非西班牙裔白人（100%，18/18），有公共保险（78%，14/18），多胎（78%，14/18），患有 OUD（100%，18/18）。没有阴道分娩的患者接受阿片类药物处方；一半（8/18）接受剖宫产分娩的患者在出院时收到一个处方。超过三分之一（18/7，39%）报告在医院和出院后一周内疼痛控制不佳（≥5/10）；剖宫产的评分高于阴道分娩。对开放式回复的定性子分析揭示了患者对产后疼痛和治疗的看法。最有效的策略，按分娩类型和疼痛程度分层，从阴道分娩和轻微疼痛的非阿片类药物到剖宫产和中度至剧烈疼痛的处方阿片类药物不等。
讨论
在实施阿片类药物节约方案后，对于阴道和剖宫产分娩的慢性产前阿片类药物使用者，产后阿片类药物的处方较少。患有 OUD 的患者报告说，使用阿片类药物节约疼痛方案可以很好地控制疼痛；然而，许多人报告说产后立即疼痛控制不佳。未来的工作应该评估产后疼痛管理方法，最大限度地减少阿片类药物治疗的风险——特别是在高危人群中。
Zotero 插件