Safe Use of Opioid Analgesics for Chronic Pain in Pregnancy

Sunday, June 16, 2013

Title: Safe Use of Opioid Analgesics for Chronic Pain in Pregnancy

Ryman Hall B4 (Gaylord Opryland)
Laura McKay, MSN, CNM , Savannah Perinatology Associates, Memorial University Medical Center, Savannah, GA
Ursula A. Pritham, PhD, WHNP-BC, FNP-BC , School of Nursing, Georgia Southern University, Statesboro, GA
Sharon Radzyminski, PhD, JD, RN , School of Nursing, Georgia Southern University, Statesboro, GA
Melissa Garno, EdD, RN , Georgia Southern University, Statesboro, GA

Discipline: Advanced Practice (AP), Childbearing (CB), Newborn Care (N), Professional Issues (PI)

Learning Objectives:
  1. Describe the challenges of managing chronic non-obstetric pain in pregnancy for obstetric and neonatal nurses and health care providers.
  2. Identify commonly utilized opioid analgesics and the typical dosages used in pregnancy.
  3. Identify signs and symptoms of Neonatal Abstinence Syndrome and how they are managed.
Submission Description:
Objective: To identify safe practices for management of chronic pain in pregnancy. Studied three commonly used opioid analgesics, compared neonatal outcomes for each of the agents, identified potential contributing factors to the incidence of Neonatal Abstinence Syndrome.

Design: Retrospective chart review

Sample: Neonatal outcomes evaluated for all singletons delivered full term during a forty two month period, whose mothers met inclusion criteria and were taking codeine, hydrocodone, or oxycodone at any dosage three or more times per week.

Methods: The first phase was the retrospective chart review. Charts for every patient delivered by the perinatology practice for the specified time frame were individually reviewed for appropriateness for the study. Data was manually gathered onto an individual data sheet and de-identified. Once all charts were reviewed and data collected, data was coded and entered into a spreadsheet. Data was analyzed for trends in neonatal outcomes using descriptive statistics. The second phase was to use the information collected combined with available data from other studies to create practice guidelines.

Implementation Strategies: Outcomes examined included gestational age at delivery, birth weight, APGAR score, NICU admission, diagnosis of Neonatal Abstinence Syndrome, length of stay, and treatment required.  Maternal demographics were evaluated for any impact they may have had on neonatal outcome trends. 

Results: Thirty one charts met criteria for the study. Nine neonates required a NICU admission. Length of NICU stay ranged from 2 to 10 days with an average NICU stay of 5 days. Two neonates required medical management with Methadone. They were the only two with a diagnosis of NAS. Six of the nine were admitted for Transient Tachypnea of the Newborn (TTN) and one with a diagnosis of poor feeder. Baseline data indicate that there is no association between NICU stay and agent used, nor between specific dosages or use of more than one agent. The study was limited by small sample size and multiple potential contributing factors to observed neonatal outcomes.

Conclusion/Implications for nursing practice: Obstetric and neonatal nurse and practitioners must become knowledgeable about the use of opioid analgesics in pregnancy. The findings of this study indicate the need for further research, but support the judicious use of opioid analgesics at minimum effective doses. Thorough evaluation of the neonate at delivery for signs of NAS and TTN is warranted, and supportive care in a NICU environment can ease the transition to extraueterine life without opioid exposure.

Keywords: chronic pain in pregnancy, opioid analgesics, Neonatal Abstinence Syndrome

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