Brief review: Obstetric care and perioperative analgesic management of the addicted patient

Review Article/Brief Review
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Abstract

Purpose

Addiction to alcohol and illicit drugs occurs in approximately 10% of the Canadian population and thus likely affects numerous perioperative patients. Provision of perioperative analgesia to these patients is challenging for physiological and behavioural reasons. Seven electronic databases were searched to identify papers addressing the perioperative management of analgesia in addicted patients.

Principal findings

There are few controlled trials on addiction care in obstetrical management, and controlled trials are lacking in obstetrical analgesia and addiction and in perioperative analgesia and addiction. The focus of the limited number of publications in the obstetrical population is on addiction management during pregnancy and does not address analgesic requirements. There are principle-based discussions on factors affecting analgesic management in patients receiving chronic opioid therapy and multimodal analgesic therapy. This discourse includes consideration of the physiological and affective factors that impact perioperative management. A number of empirically derived protocols available for managing alcohol withdrawal are based on response to the physical manifestations of withdrawal. Protocols for management of patients receiving opioid replacement therapy for opioid addiction are also well described. Nevertheless, evaluations of these protocols are lacking in clinical trials, and the impact of addiction on perioperative outcomes is unknown.

Conclusion

Perioperative analgesic management of addicted patients remains poorly understood. Most clinical trials specifically exclude addicted patients. Suggestions for management are provided.

Article de synthèse court: Les soins en obstétrique et la prise en charge de l’analgésie périopératoire pour la patiente toxicomane

Résumé

Objectif

La dépendance à l’alcool et aux drogues illicites survient chez environ 10 % de la population canadienne; par conséquent, elle touche probablement de nombreux patients en période périopératoire. La prise en charge de l’analgésie périopératoire pour ces patients est complexe, tant pour des raisons physiologiques que comportementales. Nous avons exploré sept bases de données électroniques pour en tirer les articles traitant de la prise en charge périopératoire de l’analgésie chez les patients toxicomanes.

Constatations principales

Il existe peu d’études contrôlées sur les soins aux patientes toxicomanes en matière de prise en charge obstétricale, et les études contrôlées s’intéressant à l’analgésie obstétricale et à la toxicomanie ou à l’analgésie périopératoire et à la toxicomanie font défaut. Le petit nombre de publications chez une population obstétricale porte surtout sur la prise en charge de la toxicomanie pendant la grossesse et ne traite pas des besoins analgésiques. Il existe des discussions de principe sur les facteurs affectant la prise en charge de l’analgésie des patientes recevant un traitement chronique aux opioïdes et un traitement analgésique multimodal. Ce discours comprend la prise en compte des facteurs physiologiques et affectifs qui influencent la prise en charge périopératoire. Plusieurs protocoles dérivés de données empiriques sont disponibles pour prendre en charge le sevrage de l’alcool, et ils se fondent sur la réponse aux manifestations physiques du sevrage. Il existe également des protocoles détaillant clairement la prise en charge de patientes recevant des traitements de substitution en raison d’une dépendance aux opioïdes. Ceci étant, les études cliniques ne comportent pas d’évaluations de ces protocoles, et l’impact de la toxicomanie sur le déroulement de la période périopératoire est inconnu.

Conclusion

La prise en charge de l’analgésie des patientes toxicomanes en période périopératoire demeure mal comprise. La plupart des études cliniques excluent spécifiquement les patientes toxicomanes. Nous proposons des pistes de prise en charge.

Notes

Conflicts of interest

None declared.

Disclosures

No funding was received for this work. Neither author has any commercial affiliations which are relevant to this work. D. Norman Buckley currently holds research funding from the Canadian Anesthesia Research Foundation, Canadian Institutes of Health Research, Heart and Stroke Foundation of Ontario, Johnson and Johnson, and Purdue Pharma.

Clinical trials

N/A.

Supplementary material

12630_2013_84_MOESM1_ESM.pdf (2.8 mb)
Supplementary material 1 (PDF 2831 kb)

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Copyright information

© Canadian Anesthesiologists' Society 2013

Authors and Affiliations

  1. 1.Department of Anesthesia, Michael G. DeGroote School of MedicineMcMaster UniversityHamiltonCanada

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