Pain medication requirements in patients with opioid use disorder at the time of surgical abortion: An exploratory study

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: Aspiration; Opioid dependence; Opioid use disorder; Pain control; Pain medication; Surgical abortion.