Pain management in pregnant and postpartum people with an opioid-use disorder (OUD) requires a balance between risks associated with opioid tolerance, including withdrawal or return to opioid use, considerations around 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 between the Society for Obstetric Anesthesia and Perinatology (SOAP), Society for Maternal-Fetal Medicine (SMFM), and American Society of Regional Anesthesia and Pain Medicine (ASRA) provides a framework for pain management in obstetric patients with OUD. The purpose of this consensus statement is to provide practical and evidence-based recommendations and is targeted to health care 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 OUD (eg, buprenorphine, methadone), considerations regarding urine drug testing, and other social aspects of care for maternal-infant dyads, as well as a review of current practices. The authors provide evidence-based recommendations to optimize pain management while reducing risks and complications associated with OUD in the peripartum period. Ultimately, this multidisciplinary consensus statement provides practical and concise clinical guidance to optimize pain management for people with OUD in the context of pregnancy to improve maternal and perinatal outcomes.

中文翻译：

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产科麻醉和围产期学学会、母胎医学学会和美国区域麻醉和疼痛医学学会关于阿片类药物使用障碍孕妇疼痛管理的共识声明。


患有阿片类药物使用障碍 （OUD） 的孕妇和产后患者的疼痛管理需要在与阿片类药物耐受性相关的风险之间取得平衡，包括戒断或恢复使用阿片类药物、考虑母婴二元组的社会需求，以及为通常被描述为一个人一生中将经历的最严重痛苦的分娩事件提供足够的疼痛缓解。产科麻醉和围产期医学学会 （SOAP）、母胎医学会 （SMFM） 和美国区域麻醉和疼痛医学学会 （ASRA） 之间的这份多学科共识声明为 OUD 产科患者的疼痛管理提供了一个框架。本共识声明的目的是提供实用和循证的建议，并针对产科和麻醉学的医疗保健提供者。该声明侧重于疼痛管理的产前优化、分娩镇痛和阴道分娩后疼痛管理，以及剖宫产后疼痛管理。主题包括讨论疼痛管理的非药物和药物选择、OUD 的药物管理（例如丁丙诺啡、美沙酮）、尿液药物检测的考虑、母婴二元组护理的其他社会方面，以及对当前实践的回顾。作者提供了基于证据的建议，以优化疼痛管理，同时降低围产期与 OUD 相关的风险和并发症。最终，这份多学科共识声明提供了实用和简洁的临床指导，以优化 OUD 患者在怀孕情况下的疼痛管理，从而改善孕产妇和围产期结局。