Purpose We undertook a retrospective study to compare the analgesic efficacy and effects on neonatal outcome of administering either remifentanil or fentanyl intravenous patient-controlled analgesia (IVPCA) during labour. Methods A five-year retrospective cohort study was undertaken of women with more than 24 weeks of gestation who had received either IVPCA remifentanil or fentanyl for labour analgesia at Mount Sinai Hospital. The sampling timeframe was from November 2005 to March 2010. The standard IVPCA regimen for the remifentanil group consisted of a PCA bolus 0.25 lgÁkg -1 with a lockout interval of two minutes, a four-hour limit of 3 mg, and a background infusion of 0.025-0.05 lgÁkg -1 Ámin -1 , whereas the standard IVPCA regimen for the fentanyl group consisted of a PCA bolus 25-50 lg with a lockout interval of three to six minutes and a four-hour limit of 1-1.5 mg. The following data were compared: maternal hourly pain scores (verbal pain score scale 0-10), sedation scores (scale 0-3), adverse effects, and neonatal outcomes. Mixed linear modelling was used to analyze longitudinal data on pain scores over time. The exact Wilcoxon test and the Fisher's exact test were used for other comparisons.Results Ninety-eight women were studied. There was no significant difference in the model-adjusted pain scores between the two groups (P = 0.86). There was a moderate decrease in pain scores in both groups compared with the baseline values. There was no difference in maternal side effects between the two groups, although transient oxygen desaturation was observed more frequently in the remifentanil group than in the fentanyl group (13% vs 2%, respectively; odds ratio, 7.32; 95% confidence interval [CI], 0.85 to 63.3). A larger number of neonates in the fentanyl group required resuscitation compared with neonates in the remifentanil group (59% vs 25%, respectively; odds ratio, 4.33; 95% CI, 1.75 to 10.76); adjusted (44% vs 8%, respectively; odds ratio, 8.56; 95% CI, 2.17 to 33
Background
Butorphanol is marketed as a treatment for migraines; however, evidence suggests that the harms of its use exceed the benefits. The short half-life of butorphanol places patients at high risk for opioid dependence and makes tapering a challenge. Buprenorphine/naloxone has unique pharmacological properties that are beneficial in chronic pain treatment. At this time there is limited published data on the use of micro-dosing initiation regimens in patients with chronic pain, especially in older adult patients.
Aims
This article presents the case of an older adult patient for whom a buprenorphine/naloxone micro-dosing regimen was successfully utilized to aid discontinuation of butorphanol nasal spray, assist with opioid tapering, and manage chronic pain.
Methods
This case took place in an outpatient setting while the patient was receiving care from an interprofessional chronic pain service. The electronic medical record was reviewed to obtain a summary of the case data. Informed patient consent was obtained.
Results
We present a case of an older adult patient who had been using butorphanol nasal spray for migraine and general pain management for over 20 years. The risks of ongoing use of butorphanol (i.e., inter-dose-related pain, opioid dependence, possible opioid-induced hyperalgesia, and fall risk) no longer exceeded any perceived benefit. The patient was successfully transitioned onto sublingual buprenorphine/naloxone using a micro-dosing regimen.
Conclusions
This case provides an example of the potential benefit buprenorphine/naloxone can have for patients with chronic pain and previous opioid exposure, especially older adults at risk of central adverse effects of opioids.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.