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Joseph L Reno,1 Michael Kushelev,2 Julie H Coffman,3 Mona R Prasad,4 Avery M Meyer,5 Kristen M Carpenter,5 Marilly S Palettas,6 John C Coffman2 1Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA; 2Department of Anesthesiology, The Ohio State University Medical Center, Columbus, OH, USA; 3Department of Internal Medicine, Riverside Methodist Hospital, Columbus, OH, USA; 4Department of OBGYN, OhioHealth, Columbus, OH, USA; 5Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, Columbus, OH, USA; 6Center for Biostatistics, The Ohio State University, Columbus, OH, USACorrespondence: Joseph L Reno Tel +1 206 543 2673Fax +1 206 543 2958Email renoj@uw.eduBackground: Despite the increasing prevalence of opioid use disorder (OUD) in pregnant women, there are limited studies on their anesthesia care and analgesic outcomes after cesarean delivery (CD).Methods: Patients with OUD on either buprenorphine or methadone maintenance therapy who underwent CD at our institution from 2011 to 2018 were identified. Anesthetic details and analgesic outcomes, including daily opioid consumption and pain scores, were compared between patients maintained on buprenorphine and methadone. Analgesic outcomes were also evaluated according to anesthetic type (neuraxial or general anesthesia) and daily buprenorphine/methadone dose to determine if these factors impacted pain after delivery.Results: A total of 146 patients were included (buprenorphine n=99 (67.8%), methadone n=47 (32.2%)). Among all patients: 74% had spinal/CSE, 15% epidural, and 11% general anesthesia. Anesthesia types were similar among buprenorphine and methadone patients. For spinal anesthetics, intrathecal fentanyl (median 15 μg) and morphine (median 100 μg) were commonly given (97.2% and 96.3%, respectively), and dosed similarly between groups. Among epidural anesthetics, epidural morphine (median 2 mg) was commonly administered (90.9

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, USACorrespondence: John C CoffmanDepartment of Anesthesiology, The Ohio State University Wexner Medical Center, Room N-411 North Doan Hall, 410 West 10th Avenue, Columbus, OH 43210, USATel +116142938487Fax +116142938153Email john.coffman@osumc.eduAbstract: 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