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Review
. 2024 Feb 29:17:797-813.
doi: 10.2147/JPR.S434010. eCollection 2024.

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

Victor Koltenyuk  1 , Ismat Mrad  2 , Ian Choe  1 , Mohamad Ibrahim Ayoub  3 , Sangeeta Kumaraswami  4 , Jeff L Xu  4
Affiliations
Review

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

Victor Koltenyuk et al. J Pain Res. .

Abstract

The opioid epidemic in the United States has led to an increasing number of pregnant patients with opioid use disorder (OUD) presenting to obstetric units. Caring for this complex patient population requires an interdisciplinary approach involving obstetricians, anesthesiologists, addiction medicine physicians, psychiatrists, and social workers. The management of acute pain in the parturient with OUD can be challenging due to several factors, including respiratory depression, opioid tolerance, and opioid-induced hyperalgesia. Patients with a history of OUD can present in one of three categories: 1) those with untreated OUD; 2) those who are currently abstinent from opioids; 3) those being treated with medications to prevent withdrawal. A patient-centered, multimodal approach is essential for optimal peripartum pain relief and prevention of adverse maternal and neonatal outcomes. Medications for opioid use disorder (MOUD), previously referred to as medication-assisted therapy (MAT), include opioids like methadone, buprenorphine, and naltrexone. These are prescribed for pregnant patients with OUD, but appropriate dosing and administration of these medications are critical to avoid withdrawal in the mother. Non-opioid analgesics such as acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) can be used in a stepwise approach, and regional techniques like neuraxial anesthesia and truncal blocks offer opioid-sparing options. Other medications like ketamine, clonidine, dexmedetomidine, nitrous oxide, and gabapentinoids show promise for pain management but require further research. Overall, a comprehensive pain management strategy is essential to ensure the well-being of both the mother and the fetus in pregnant patients with OUD.

Keywords: buprenorphine; methadone; naltrexone; opioids; pregnancy.

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Conflict of interest statement

The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Practical approach for managing pain in the parturient with untreated OUD during vaginal delivery (left) and cesarean section (right).
Figure 2
Figure 2
Practical approach for managing pain in the opioid abstinent parturient during vaginal delivery (left) and cesarean section (right).
Figure 3
Figure 3
Practical approach for managing pain in the parturient with on MOUD during vaginal delivery (left) and cesarean section (right).
See this image and copyright information in PMC

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