Use of epidural clonidine for the management of analgesia in the opioid addicted parturient on buprenorphine maintenance therapy: an observational study

International Journal of Obstetric Anesthesia
M R HoytM Temple

Abstract

Management of labor analgesia and post-cesarean delivery pain is challenging in the patient taking buprenorphine as opioid addiction maintenance therapy. We observed whether substituting clonidine for fentanyl in an epidural solution would provide adequate analgesia for labor and after cesarean delivery. We substituted our standard 2 µg/mL fentanyl in 0.0625% bupivacaine epidural solution with 2 µg/mL clonidine in 0.0625% bupivacaine, or 1.2 µg/mL clonidine in 0.1% bupivacaine, for labor and post-cesarean analgesia in parturients on buprenorphine therapy. All cesarean deliveries were performed with a combined spinal-epidural technique and the catheters maintained for immediate postoperative analgesia using an epidural infusion. Catheters were discontinued the next day and patients were then managed with other analgesics based on obstetric preference. We recorded pain scores during labor and in the immediate post-surgical period; and supplemental medications given after epidural catheter removal. Fourteen patients were included in the study, of whom seven presented in spontaneous labor and seven had elective cesarean delivery. All laboring patients achieved good analgesia, and five of seven avoided supplemental opioid use in the...Continue Reading

Citations

Feb 11, 2020·International Anesthesiology Clinics·Erica HollandChloe Zera
Oct 2, 2020·Current Opinion in Anaesthesiology·David E Arnolds
Jan 19, 2021·BJA Education·B Shatil, R Smiley
Mar 9, 2021·Current Anesthesiology Reports·Kishan Patel, Mark Zakowski
May 4, 2021·Current Opinion in Anaesthesiology·Jarna R ShahJessica Coker
Jun 9, 2021·International Anesthesiology Clinics·Laurence E Ring, Ruth Landau

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