Clinical Edge

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Postpartum Pain & Fatigue Management

Obstet Gynecol; ePub 2018 Jul; ACOG

Because pain and fatigue can interfere with a women’s ability to care for herself and her infant and untreated pain is associated with a risk of greater opioid use, postpartum depression, and development of persistent pain, postpartum pain management is crucial during this period. The American College of Obstetricians and Gynecologists (ACOG) make the following recommendations regarding postpartum pain management:

  • Pain can interfere with a woman’s ability to care for herself and her infant. Nonpharmacologic and pharmacologic therapies are important components of postpartum pain management.
  • Because of the variation in types and intensity of pain women experience during the early postpartum period, as well as the concern that 1 in 300 opioid-naive patients exposed to opioids after cesarean birth will become persistent users of opioids, a stepwise approach using a multimodal combination of agents can enable obstetrician–gynecologists and other obstetric care providers to effectively individualize pain management for women in the postpartum period.
  • For postoperative cesarean pain, standard oral and parenteral analgesic adjuvants include acetaminophen, nonsteroidal antiinflammatory drugs (NSAIDs), opioids, and opioids that are in combination formulations with either acetaminophen or an NSAID.
  • Parenteral or oral opioids should be reserved for treating breakthrough pain when analgesia from the combination of neuraxial opioids and nonopioid adjuncts becomes inadequate.
  • A shared decision-making approach to postpartum discharge opioid prescription can optimize pain control while reducing the number of unused opioid tablets.
  • If a codeine-containing medication is the selected choice for postpartum pain management, medication risks and benefits, including patient education regarding newborn signs of toxicity, should be reviewed with the family.
  • Regardless of the medication selected, it is prudent to counsel women who are prescribed opioid analgesics about the risk of central nervous system depression in the woman and the breastfed infant. Duration of use of opiate prescriptions should be limited to the shortest reasonable course expected for treating acute pain.

Citation:

Postpartum pain management. ACOG Committee Opinion No. 742. American College of Obstetricians and Gynecologists. Obstet Gynecol. 2018:132(1):e35-e43. doi:10.1097/AOG.0000000000002683.