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Peripartum Management for Patients Receiving Medication for Opioid Use Disorder
Henry Paiste1, Brendan Lynch1, Grace Lim2
1Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh School of Medicine, UPMC Magee Women's Hospital, 300 Halket Street, Pittsburgh, PA 15213, USA.
Abstract:
This review discusses the rising impact of opioid use disorder (OUD) on peripartum care, highlighting the maternal and neonatal risks, including neonatal abstinence syndrome. It traces the US opioid crisis from aggressive 1990s prescribing to 2016 Center for Disease Control guidelines and notes enduring regional disparities in opioid prescriptions. The text distinguishes OUD from opioid-induced hyperalgesia and explains the pharmacology of methadone (full agonist) and buprenorphine (partial agonist), along with their implications for treatment during pregnancy. In obstetric anesthesia, coordinated, multimodal pain management is essential, with medication for opioid use disorder continuation, early neuraxial analgesia, and avoidance of withdrawal-precipitating agents.
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