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Continuous Epidural Hydromorphone Infusion for Post-Cesarean Delivery Analgesia in a Patient on Methadone Maintenance Therapy: A Case Report

Authors Stanislaus MA, Reno JL, Small RH, Coffman JH, Prasad M, Meyer AM, Carpenter KM, Coffman JC

Received 18 December 2019

Accepted for publication 17 April 2020

Published 28 April 2020 Volume 2020:13 Pages 837—842

DOI https://doi.org/10.2147/JPR.S242271

Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr E Alfonso Romero-Sandoval


Mellany A Stanislaus,1 Joseph L Reno,1 Robert H Small,1 Julie H Coffman,2 Mona Prasad,3 Avery M Meyer,4 Kristen M Carpenter,4 John C Coffman1

1Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA; 2Department of Internal Medicine, Riverside Methodist Hospital, Columbus, OH, USA; 3Department of OBGYN, Riverside Methodist Hospital, Columbus, OH, USA; 4Department of Psychiatry, The Ohio State University Wexner Medical Center, Columbus, OH, USA

Correspondence: John C Coffman
Department of Anesthesiology, The Ohio State University Wexner Medical Center, Room N-411 North Doan Hall, 410 West 10th Avenue, Columbus, OH 43210, USA
Tel +116142938487
Fax +116142938153
Email john.coffman@osumc.edu

Abstract: The prevalence of opioid use disorder (OUD) in the United States has more than quadrupled over the past two decades. This patient population presents a number of challenges to clinicians, including difficult pain management after surgical procedures due to the development of opioid tolerance. Significantly greater opioid consumption and pain scores after cesarean delivery have been reported in patients with OUD compared to other obstetric patients. A multi-modal analgesic regimen is generally recommended, but there are few well-established pain management strategies after cesarean delivery specific to patients with OUD. We present the case of a patient with OUD maintained on daily methadone that received a continuous epidural hydromorphone infusion for post-cesarean analgesia, a technique not previously reported in obstetric patients and only rarely described for patients undergoing other surgical procedures. The patient received epidural anesthesia for cesarean delivery, and after surgery, the epidural catheter was left in place for the epidural hydromorphone infusion, initiated at 140 mcg/hr and continued for approximately 40 hrs. This strategy reduced her average daily oral opioid consumption by 97%, reduced self-reported pain scores, shortened the length of hospitalization and improved ability to ambulate compared to her previous cesarean delivery. The use of continuous epidural hydromorphone infusion was effective in this case, and this analgesic technique may also be applicable to other types of surgical procedures with the potential for significant post-operative pain, particularly in patients with OUD.

Keywords: continuous epidural hydromorphone, opioid use disorder, cesarean delivery, medication-assisted treatment, methadone

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