Multimodal Acute Pain Management in the Parturient with Opioid Use Disorder: A Review.

Area of Science:

• Obstetrics and Gynecology
• Anesthesiology
• Addiction Medicine
• Pharmacology

Background:

• Rising opioid use disorder (OUD) in pregnant individuals necessitates specialized obstetric care.
• Managing acute pain in parturients with OUD presents challenges like respiratory depression and opioid tolerance.
• Patients with OUD may be untreated, abstinent, or on medication for opioid use disorder (MOUD).

Purpose of the Study:

• To outline a patient-centered, multimodal pain management strategy for pregnant patients with OUD.
• To review current and emerging pharmacologic and non-pharmacologic pain relief options.
• To emphasize the importance of an interdisciplinary approach for optimal outcomes.

Main Methods:

• Literature review of pain management strategies in pregnant patients with OUD.
• Analysis of current guidelines and research on medications for opioid use disorder (MOUD).
• Discussion of non-opioid analgesics, regional anesthesia, and adjuvant medications.

Main Results:

• A stepwise, multimodal approach combining non-opioid analgesics, regional techniques, and MOUD is recommended.
• Careful dosing of MOUD (methadone, buprenorphine, naltrexone) is crucial to prevent maternal withdrawal.
• Opioid-sparing strategies like neuraxial anesthesia and truncal blocks are effective.
• Emerging agents (ketamine, clonidine, etc.) show potential but need further investigation.

Conclusions:

• Comprehensive pain management is vital for pregnant patients with OUD.
• An interdisciplinary team approach ensures optimal maternal and neonatal outcomes.
• Tailored MOUD and multimodal analgesia are key components of effective peripartum care.