Postoperative Cesarean Pain Management and Opioid Use Disorder: Anticipate the Need for Higher Opioid Doses and Communicate Expectations With Patients and the Obstetric Team.

Abstract

Peripartum care coordination for the obstetric patient on medications for opioid use disorder (OUD) can be challenging and is best accomplished by a multidisciplinary team. The benefits of buprenorphine, methadone, or naltrexone initiation or continuation in pregnancy are well established and beyond the scope of this commentary; instead, we narrow the focus on planning for sufficient pain management in labor and during recovery from cesarean delivery. Conversations about postoperative pain management should begin in the antepartum period, and likely do for the 15%-20% of individuals with a history of cesarean delivery who schedule a repeat cesarean. Nevertheless, 18%-20% of pregnant individuals deliver via primary cesarean delivery, underscoring the need for universal antepartum counseling on the possibility of undergoing and recovering from an unanticipated major abdominal surgery. The optimal intrapartum and postpartum pain regimen for individuals with OUD remains incompletely characterized as research on this topic is limited. Enhanced understanding of the unique needs of postpartum individuals with OUD will aid in closing knowledge gaps and elevate the standard of care in this population.