Pain Medication Use in Opiate Dependent Patients During Surgical Abortion [6P]

INTRODUCTION: There are currently limited guidelines for pain management for patients who are opiate dependent and undergoing minor surgical procedures. We assessed the differences in pain medication use for patients with and without opiate dependence and explored factors associated with need for pain medication during surgical abortion. METHODS: We conducted a chart review of patients undergoing surgical abortion from 2012 to 2017 at a single urban university hospital. We compared the doses of administered benzodiazepines and opiates for patients who were opiate dependent to a random sample of non-opiate dependent women undergoing the same procedures. We assessed associations of opiate replacement therapy use and outpatient pain medication. RESULTS: We identified 64 women with opiate dependence who met eligibility criteria. The mean fentanyl dose was higher for opiate dependent (n=64) than non-dependent (n=64) patients (110 mg vs 88 mg, p=<0.001). Average midazolam doses were only minimally different between groups (2.7 mg and 2.3 mg, p=0.001). Within the opiate dependent cohort, use of replacement therapies such as methadone (n=17) or buprenorphine (n=28) did not impact pain medication requirements. CONCLUSION: Higher doses of fentanyl may be required to achieve adequate pain control for patients with opiate dependence during surgical abortion. The use of replacement therapy does not impact dosing. These findings can inform provider expectations related to doses of narcotics for opiate dependent patients.