Addiction and Pregnancy: Analysis of an Intervention Protocol for Post-Cesarean Pain Control
ACOG ePoster. Kunycky C. Apr 27, 2018; 211712; 38C
Christina Kunycky
Christina Kunycky
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Introduction: As the scope of the opioid-addiction epidemic increases, so does the need for supportive providers and for comprehensive interventions to best manage a patient's addiction. Treating pain following cesarean section necessitates such an intervention as hyperalgesia and increased tolerance have been well established in patients treated with methadone and buprenorphine.

Methods: A quality improvement project was conducted to guide postoperative pain control for patients on medication assisted treatment (MAT) through the University of Massachusetts Medical School's Green Clinic for Addiction and Recovery. Providers were instructed to administer a regimen of increased post-operative opiate pain medication for an initial cohort of Green clinic patients scheduled to undergo a primary or repeat cesarean section. A retrospective chart review was then conducted, collecting pain scores and quantity of opiate pain medication given from the time of delivery to 72 hours post-operative. Adherence to the protocol was determined by type and quantity of pain medication received.

Results: Of 16 Green clinic patients to receive the protocol, only 41% of patients received the treatment protocol and the remaining 59% received standard post-operative orders. There was no significant difference in pain scores between groups receiving the treatment protocol vs. those receiving standard postoperative orders.

Conclusion/Implications: Failure to follow the protocol for patients on MAT indicates the need for more effective systems-based implementation protocols but also the need for concurrent education of healthcare workers involved in the care of patients with addiction, as stigma and knowledge gaps cannot be excluded as factors contributing to failure to follow the protocol.
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