Statement on Neuraxial Medication Shortage and Alternatives
Developed by: Committee on Obstetrics
Original Approval: October 18, 2023
Drug shortages have been common for over a decade, exacerbated by the COVID-19 pandemic, reaching an all-time peak in 2022. By the end of 2022, a US Senate report indicates new drug shortages increased by almost 30%, with the average drug shortage lasting 1.5 years, with many critical drug products having been in shortage for over a decade.1 The Food and Drug Administration (FDA) lists common anesthetics among the medications most affected by shortages.
Neuraxial medications commonly used in obstetric anesthesia have also been greatly affected, including local anesthetics (lidocaine and bupivacaine) that have had shortages for over 10 years, as well as opioids used for pain control during labor, cesarean delivery, and for post-operative pain relief. The American Society of Anesthesiologists (ASA) has remained engaged on drug shortages for several years.2 Drug shortages create significant patient safety concerns, including possible medication errors.3 The American Society of Health System Pharmacists (ASHP) has guidelines on managing shortages that include planning ahead.4
Anesthesiologists, particularly in obstetric anesthesia, have been forced to use alternative neuraxial medications for their patients, which may be less effective and/or less familiar to them, thus increasing the potential for medication errors.3 Below are detailed tables for relative equivalence/alternatives to the most commonly used medications in obstetric anesthesiology that are, or have been, on the drug shortage list. While these choices are supported by the scientific literature, note that many commonly administered neuraxial medications may or may not have specific FDA approval for such indications. Thus, administration of any medication is the sole decision of the individual practitioner.
The ASA continues to work with the FDA and other organizations on anesthetic drug shortages. Other information listing current drug shortages can be found at the ASHP5 website as well as the FDA website.6 Individuals may report drug shortages at [email protected].
- United States Senate Committee on Homeland Security & Governmental Affairs Majority Staff Report on Short Supply https://www.hsgac.senate.gov/wp-content/uploads/Drug-Shortages-HSGAC-Majority-Staff-Report-2023-03-22.pdf
- American Society of Health-System Pharmacists. ASHP guidelines on managing drug product shortages. Am J Health-Syst Pharm. 2018; 75:1742-50.
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