Comparison of Different Methods of Pain Control After Cesarean Section for Patients on Buprenorphine or Methadone
Status:
Withdrawn
Trial end date:
2014-04-01
Target enrollment:
Participant gender:
Summary
More and more women are on buprenorphine or methadone during pregnancy for a history of
opioid addiction. Currently, pain control after cesarean section for women already on these
medications, if they need operative delivery, is a challenge due to the pharmacology of those
drugs. They have higher pain scores and 45-47% higher opiates requirement. To improve pain
control, some unique regional anesthesia techniques have been employed, besides opioid and
non-opioid medication management through the oral, intravenous, and/or neuraxial (spinal or
epidural) route. One is a TAP block ( transversus abdominis plane block), a regional
anesthesia procedure in which long acting local anesthetic, such as ropivacaine, is injected
on both sides of the patient's abdomen to numb the nerves supplying the abdominal wall, or
the surgical site. Another is a patient - controlled epidural, a small flexible catheter that
is inserted in the back into the epidural space near the spine, which bathes the spinal nerve
roots with long acting local anesthetic, such as bupivacaine, and with an opioid, such as
fentanyl, to numb the nerves going to the surgical site. Through an epidural pump, the
patient receives a continuous infusion of local anesthetic and can delivery more medication
as needed through a bolus feature. There have case reports, or case by case accounts, of
these techniques, and it is suspected these techniques result in better pain control with
minimal side effects. No clinical, human or animal, has evaluated these techniques in a
controlled and through manner, either comparing the two techniques to each other or comparing
them to the common care of opioid and non-opioid medication management through the oral,
intravenous, and/or neuraxial route, including neuraxial hydromorphone or morphine.
Phase:
N/A
Details
Lead Sponsor:
Dartmouth-Hitchcock Medical Center
Collaborators:
Brigham and Women's Hospital Massachusetts General Hospital