Abstract
Objective
To assess sedation medication dosage differences between patients with and without
opioid use disorder at the time of surgical abortion.
Study Design
We performed a retrospective cohort study, identifying patients obtaining a surgical
abortion in our ambulatory procedure unit between 2012 and 2017. We identified 64
patients with documented opioid use disorder at the time of their procedure and assigned
64 patients without opioid use disorder to a control cohort. We reviewed patient characteristics
and calculated total doses of midazolam and fentanyl administered to patients. We
used multivariate linear regression modelling to model the amount of medication administered
to each group while controlling for confounders.
Results
The exposed and unexposed cohorts were similar in terms of baseline characteristics
except for race. The cohort of patients with opioid use disorder was predominantly
White (n = 55, 86%) and completely English speaking (n = 64, 100%), whereas the control cohort was majority Black (n = 39, 61%) and mostly English speaking (n = 44, 69%) On average, patients with opioid use disorder received 22 mcg more fentanyl
(110 mcg vs 88 mcg, p < 0.001) and 0.4 mg more midazolam (2.7 mg vs 2.3 mg, p = 0.001) than patients without opioid use disorder. After adjusting for prior abortions,
parity, English speaking status, psychiatric conditions, and education, we found smaller
differences in both fentanyl (15 mcg, 95% CI 1.7, 28.2 mg) and midazolam dosages (0.3
mg, 95% CI -0.01, 0.6) between groups.
Conclusions
Patients with and without opioid use disorder received similar doses of midazolam
and fentanyl for moderate sedation for surgical abortion.
Implications
This study suggests that standard medication titration protocols utilized with moderate
sedation for surgical abortions need not be changed for patients with opioid use disorder.
Moderate sedation can be a helpful option for pain control for this vulnerable population.
Keywords
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References
- Unintended pregnancy in opioid-abusing women.J Subst Use. 2011; 40: 199-202
- Unplanned pregnancy and contraceptive use in women attending drug treatment services.Aust N Z J Obstet Gynaecol. 2012; 52: 146-150
- Second-trimester surgical abortion practices: a survey of National Abortion Federation members.Contraception. 2008; 78: 492-499
- Pain management.in: Paul M. Grimes D. Lichtenberg S. Stubblefield P. Borgatta L. Creinin M. Management of unintended and abnormal pregnancy: comprehensive abortion care. Blackwell Press, Hoboken, NJ2009 (Chapter 8)
- Perioperative management of acute pain in the opioid-dependent patient.Anesthesiology. 2004; 101: 212-227
Saberski L., Postoperative pain management for the patient with chronic pain, acute pain: mechanisms and management. Edited by Sinatra R, Hord A, Ginsberg B, Preble L. St. Louis, Missouri, Mosby Yearbook, 1992, pp 422–31
Pain management for patients with opioid use disorder. Online Education Modules. National Abortion Federation; 2019.
Article info
Publication history
Published online: July 05, 2021
Accepted:
June 30,
2021
Received in revised form:
June 28,
2021
Received:
November 12,
2020
Identification
Copyright
© 2021 Elsevier Inc. All rights reserved.
