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Obstetrics & Gynecology 2007;110:261-266
© 2007 by The American College of Obstetricians and Gynecologists
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ORIGINAL RESEARCH

Intrapartum and Postpartum Analgesia for Women Maintained on Methadone During Pregnancy

Marjorie Meyer, MD1, Katherine Wagner, MD1, Anna Benvenuto1, Dawn Plante, RN1 and Diantha Howard, MS2

From the 1Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, and the 2Department of Statistics, University of Vermont College of Medicine, Burlington, Vermont.

OBJECTIVE: To determine whether methadone maintenance alters intrapartum or postpartum pain or medication requirements.

METHODS: Sixty-eight patients treated with methadone for opiate dependence during pregnancy (vaginal n=35; cesarean n=33) were matched retrospectively to control women. Analgesic medication and pain scores (0–10) were extracted from the medical record. The primary endpoint was opiate use postpartum (oxycodone equivalents). The secondary endpoints were pain scores and intrapartum analgesia.

RESULTS: There were no differences in intrapartum pain or analgesia. After vaginal birth, methadone-maintained women experienced increased pain (methadone, 2.7 [1.9–5.0]; control, 1.4 [0.5–3.0], P=.001) but no increase in opiate use ([mean±standard deviation] methadone 12.7±32.1; control 6.8±12.7 mg/24 h, P=.33); after cesarean delivery both pain (methadone, 5.3 [4.1–6.0]; control, 3.0 [2.2–3.9], P=.001) and opiate use (methadone, 91.6±51.8; control, 54.0±18.6 mg/24 h, P=.001) increased.

CONCLUSION: Methadone-maintained women have similar analgesic needs and response during labor, but require 70% more opiate analgesic after cesarean delivery.

LEVEL OF EVIDENCE: II






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