ACOG has published a Clinical Consensus document on the management of postpartum pain. The recommendations focus on the use of “a stepwise multimodal approach using a combination of agents with different mechanisms of action to effectively individualize pain management in the postpartum period.” In general, the first step is nonopioid analgesics, “followed by opioids of lower and then higher potency as needed.”
Perioperative Pain Control
Beyond Immediate Postop Period: Use Stepwise Multimodal Analgesia
Discharge Medications and Opioids
NSAIDs and Acetaminophen
When making decisions about whether to initiate opioid therapy for pain during pregnancy, clinicians and patients together should carefully weigh benefits and risks. For pregnant persons already receiving opioids, clinicians should access appropriate expertise if tapering is being considered because of possible risks to the pregnant patient and the fetus if the patient goes into withdrawal
For pregnant persons with opioid use disorder, medication for opioid use disorder (buprenorphine or methadone) is the recommended therapy and should be offered as early as possible in pregnancy to prevent harms to both the patient and the fetus
FDA Warning Against Tramadol or Codeine
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