Neuraxial clonidine is not associated with lower post-cesarean opioid consumption or pain scores in parturients on chronic buprenorphine therapy: a retrospective cohort study.

Autor: Taylor MG; Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, USA. taylormg@med.umich.edu.; Department of Anesthesiology, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, USA. taylormg@med.umich.edu., Bauchat JR; Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, USA., Sorabella LL; Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, USA., Wanderer JP; Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, USA.; Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, USA., Feng X; Department of Biostatistics, Vanderbilt University Medical Center, Nashville, USA., Shotwell MS; Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, USA.; Department of Biostatistics, Vanderbilt University Medical Center, Nashville, USA., Ende HB; Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, USA.
Jazyk: angličtina
Zdroj: Journal of anesthesia [J Anesth] 2024 Jun; Vol. 38 (3), pp. 339-346. Date of Electronic Publication: 2024 Mar 10.
DOI: 10.1007/s00540-024-03314-8
Abstrakt: Purpose: Adequate post-cesarean delivery analgesia can be difficult to achieve for women diagnosed with opioid use disorder receiving buprenorphine. We sought to determine if neuraxial clonidine administration is associated with decreased opioid consumption and pain scores following cesarean delivery in women receiving chronic buprenorphine therapy.
Methods: This was a retrospective cohort study at a tertiary care teaching hospital of women undergoing cesarean delivery with or without neuraxial clonidine administration while receiving chronic buprenorphine. The primary outcome was opioid consumption (in morphine milligram equivalents) 0-6 h following cesarean delivery. Secondary outcomes included opioid consumption 0-24 h post-cesarean, median postoperative pain scores 0-24 h, and rates of intraoperative anesthetic supplementation. Multivariable analysis evaluating the adjusted effects of neuraxial clonidine on outcomes was conducted using linear regression, proportional odds model, and logistic regression separately.
Results: 196 women met inclusion criteria, of which 145 (74%) received neuraxial clonidine while 51 (26%) did not. In univariate analysis, there was no significant difference in opioid consumption 0-6 h post-cesarean delivery between the clonidine (8 [IQR 0, 15]) and control (1 [IQR 0, 8]) groups (P = 0.14). After adjusting for potential confounders, there remained no significant association with neuraxial clonidine administration 0-6 h (Difference in means 2.77, 95% CI [- 0.89 to 6.44], P = 0.14) or 0-24 h (Difference in means 8.56, 95% CI [- 16.99 to 34.11], P = 0.51).
Conclusion: In parturients receiving chronic buprenorphine therapy at the time of cesarean delivery, neuraxial clonidine administration was not associated with decreased postoperative opioid consumption, median pain scores, or the need for intraoperative supplementation.
(© 2024. The Author(s) under exclusive licence to Japanese Society of Anesthesiologists.)
Databáze: MEDLINE
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