Why we are recommending this best practice
Strategies for implementation
- For severe pain, develop policies for maintenance of an epidural analgesia catheter during the first few postpartum days. These policies will limit the dependence on pain medications to which the mother may have developed tolerance.
- Consider Transverse Abdominis Plane (TAP) block, Quadratus Lumborum Block (QL2), or paravertebral blocks/catheters with the consultation of an anesthesiologist. Create facilities, training, and procedures for providers to maintain these catheters and advise patients on their benefits and use.
- Schedule adjuvant medications including non-steroidal anti-inflammatory medications and acetaminophen to reduce the need for opioid dose escalation. Develop procedures and training for the administration of other adjuvant medications including gabapentin or pregabalin, or short-term ketamine in consultation with and under the supervision of an anesthesiologist.
- Consider local analgesic and other analgesic patches for postsurgical pain.
- Do not routinely give opioids above maintenance doses for vaginal births.
- Seek your patient’s participation
- Help your patient explore and compare treatment options
- Assess your patient’s values and preferences
- Reach a decision with your patient
- Evaluate the decision
- Ramsay Sedation Scale: Designed for use in critically ill adults that has broad applicability in evaluation of the range between agitation and over sedation in response to sedatives and analgesics.
- COWS: A clinical opioid withdrawal scale designed to monitor signs of opioid withdrawal.
- Considerations for Administration of Buprenorphine and Methadone.
- Considerations for Treatment of Opioid Use Disorder in Pregnancy.
- “SHARE Approach” AHRQ. Shared Decision Making.
- Ansari J, Carvalho B, Shafer SL, Flood P. Pharmacokinetics and Pharmacodynamics of Drugs Commonly Used in Pregnancy and Parturition. Anesthesia and analgesia. 2016;122(3):786-804.