Abstract
Pain management in pregnant and postpartum people with an opioid use disorder requires a balance among the risks associated with opioid tolerance, including withdrawal or return to opioid use, considerations around the social needs of the maternal-infant dyad, and the provision of adequate pain relief for the birth episode that is often characterized as the worst pain a person will experience in their lifetime. This multidisciplinary consensus statement from the Society for Obstetric Anesthesia and Perinatology, the Society for Maternal-Fetal Medicine, and the American Society of Regional Anesthesia and Pain Medicine provides a framework for pain management in obstetrical patients with opioid use disorder. The purpose of this consensus statement is to provide practical and evidence-based recommendations and is targeted to healthcare providers in obstetrics and anesthesiology. The statement is focused on prenatal optimization of pain management, labor analgesia and postvaginal delivery pain management, and postcesarean delivery pain management. Topics include a discussion of nonpharmacologic and pharmacologic options for pain management, medication management for opioid use disorder (eg, buprenorphine, methadone), considerations regarding urine drug testing and other social aspects of care for maternal-infant dyads, and a review of current practices. The authors provide evidence-based recommendations to optimize pain management while reducing risks and the complications associated with opioid use disorder in the peripartum period. Ultimately, this multidisciplinary consensus statement provides practical and concise clinical guidance to optimize pain management for people with opioid use disorder in the context of pregnancy to improve maternal and perinatal outcomes.