Journal of Pain Research (Feb 2024)
Multimodal Acute Pain Management in the Parturient with Opioid Use Disorder: A Review
Abstract
Victor Koltenyuk,1 Ismat Mrad,2 Ian Choe,1 Mohamad Ibrahim Ayoub,3 Sangeeta Kumaraswami,4 Jeff L Xu4 1School of Medicine, New York Medical College, Valhalla, NY, USA; 2Anesthesiology and Perioperative Medicine, University of Rochester, Rochester, NY, USA; 3Department of Anesthesiology, New York University Grossman School of Medicine, New York, NY, USA; 4Department of Anesthesiology, Westchester Medical Center/New York Medical College, Valhalla, NY, USACorrespondence: Jeff L Xu, Department of Anesthesiology, Westchester Medical Center/New York Medical College, 100 Woods Road, Valhalla, NY, 10595, USA, Tel +1 914 493 7693, Fax +1 914 493 7927, Email [email protected]: 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: opioids, pregnancy, buprenorphine, methadone, naltrexone
