| Vaginal delivery | Cesarean delivery |
Chronic opioid use (ie, OUD on MAT, OUD untreated, or taking opioids for chronic pain) | Labor analgesia: - Continue regularly scheduled opioid
- Neuraxial labor analgesia preferred
- If neuraxial analgesia is not possible, IV PCA
- Avoid nitrous oxide; use with opioids can lead to respiratory depression
- Avoid mixed agonist/antagonist medications (eg, nalbuphine, pentazocine, butorphanol) due to risk of withdrawal
Postpartum analgesia: - Regularly scheduled acetaminophen and NSAIDs
- For patients with third or fourth degree vaginal lacerations, consider neuraxial long-acting opioid (ie, preservative free morphine or hydromorphone)
| Anesthesia: - Neuraxial anesthesia preferred
- Anticipate need for nonpharmacologic support +/– sedatives during procedure
Post cesarean analgesia: - Regularly scheduled acetaminophen and NSAIDs.
- For patients who have neuraxial anesthesia:
- Neuraxial long acting opioids (ie, preservative free morphine or hydromorphone)
- For patients who have general anesthesia and for rescue analgesia:
- TAP or QL blocks, PCA, local anesthetic wound infiltration catheter, or continuous epidural analgesia
|
Patients with OUD now abstinent | Labor analgesia: - Neuraxial labor analgesia preferred
- If neuraxial analgesia is not possible: nitrous oxide
Postpartum analgesia: - Regularly scheduled acetaminophen and NSAIDs
- For patients with third or fourth degree vaginal lacerations, consider neuraxial long-acting opioid (ie, preservative free morphine or hydromorphone)
| Anesthesia: - Neuraxial anesthesia preferred
Post cesarean analgesia: - Regularly scheduled acetaminophen and NSAIDs.
- For patients who have neuraxial anesthesia:
- Neuraxial long acting opioids (ie, preservative free morphine or hydromorphone)
- For patients who have general anesthesia and for rescue analgesia:
- TAP or QL blocks, local anesthetic wound infiltration catheter and/or continuous epidural analgesia
|
Patients with OUD now abstinent, taking naltrexone | Labor analgesia: - Neuraxial labor analgesia with local anesthetic only without opioids preferred
- Avoid systemic opioids
- If neuraxial analgesia is not possible, nitrous oxide is an option
Postpartum analgesia: - Regularly scheduled acetaminophen and NSAIDs
| Anesthesia: - Neuraxial anesthesia preferred, local anesthetic only without opioids
Post cesarean analgesia: - Regularly scheduled acetaminophen and NSAIDs.
- TAP or QL blocks, or continuous epidural analgesia with local anesthetic, or local anesthetic wound infiltration/catheter
- Avoid reliance on neuraxial or systemic opioids*
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