With a history of multisubstance abuse previous

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with a history of multisubstance abuse, previous failed attempts at detoxification, or who are currently on a methadone maintenance dose (Reddy et al.). Labor analgesia can prove chal- lenging, but efficacy of local anesthet- ics is not affected by opioid dependence. Opioids added into an epidural solution may not be as effec- tive, so consideration may be given to using higher concentrations of local anesthetics or adding other nonopi- oid anesthetics to achieve adequate labor pain relief (Reddy et al., 2017). Postpartum pain relief requires use of nonsteroidal anti-inflammatory drugs (NSAIDs) with acetaminophen when safe and appropriate while continu- ing opioid maintenance treatments after vaginal births (Reddy et al.). For cesarean births, NSAIDs and acet- aminophen when able and adding other nonopioid treatments such as gabapentin or nerve blocks may pro- vide relief. When opioids are required, avoidance of “triggering” opioids like oxycodone is recommended with close observation for symptoms of oversedation (Reddy et al.). Postpar- tum is a time when opioid-naïve women are first exposed to opioids with recent data suggesting that 1 in Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.
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