Author Credentials

Kevin D. White MD, MEd Shirin Azadi BS Nadim Bou Zgheib MD Brenda L. Mitchell MD


buprenorphine, ERAS, pain control, cesarean delivery, liposomal bupivacaine


Obstetrics and Gynecology




Prescription drug abuse presents a significant challenge to the management of post operative pain.Pain control amongst the opioid addicted patient can be especially challenging. We aimed to improve pain control after caesarian delivery with enhanced recovery in patients who are on buprenorphine medication-assisted therapy for the treatment of opioid addiction.

Materials and Methods:

We conducted a pilot study by implementing a protocol using liposomal bupivacaine injected at the time of cesarean delivery. Patients were then given 500mg acetaminophen every 4 hours, 800mg ibuprofen every 8 hours and 0.3mg IV buprenorphine every 6 hours as needed. The patients’ maintenance dosing of buprenorphine was divided into doses throughout the day. In addition, patients were ambulated 4 hours after surgery and had their catheter removed from their bladder as soon as they could safely ambulate. Eleven patients were prospectively recruited and then compared to a retrospective sample of seventeen patients.


Patients in the treatment group reported 27% lower pain scores (p


Our enhanced recovery protocol is an effective alternative to traditional pain control and is associated with a significant reduction in both pain scores and use of breakthrough IV buprenorphine as well as lower charges.