Authors: Roya S et al.
International Journal of Obstetric Anesthesia, 2025. | DOI: Not Provided
This retrospective cohort study evaluated postoperative opioid consumption and pain outcomes in patients with opioid use disorder (OUD) maintained on methadone or buprenorphine undergoing cesarean delivery under neuraxial anesthesia with intrathecal morphine. The primary hypothesis was that standardized neuraxial anesthesia combined with multimodal non-opioid analgesics would yield similar postoperative opioid use between OUD patients and opioid-naïve controls.
A total of 125 OUD patients (methadone n=95; buprenorphine n=30) were propensity-matched 1:1 with opioid-naïve controls. Patients on opioid agonist therapy had significantly higher 48-hour opioid consumption (median 82.5 mg vs. 25.0 mg MME; P<0.001), higher average pain scores (4.6 vs. 3.4; P<0.001), and higher peak pain scores (7.0 vs. 4.8; P<0.001). Mental health diagnoses independently correlated with increased opioid consumption. However, hospital length of stay was similar between groups.
The study concluded that despite optimized multimodal analgesia, patients maintained on opioid agonists had higher postoperative opioid needs and pain scores following cesarean delivery. Mental health comorbidities significantly influenced opioid consumption, highlighting the need for tailored pain management strategies in this patient population.
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Authors: Roya S et al. 2025.
International Journal of Obstetric Anesthesia. (DOI not provided)
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