What is the term for administering pain medication to a pregnant patient close to labor?

Pain Medication Administration Near Labor

The term for administering pain medication to a pregnant patient close to labor is labor analgesia or obstetric analgesia, with neuraxial analgesia (epidural or combined spinal-epidural) being the most effective method available 1, 2, 3.

Primary Terminology and Methods

Neuraxial analgesia is the gold standard term used in obstetric practice for pain management during labor and delivery 1, 2. This encompasses:

• Epidural analgesia: Continuous infusion of dilute local anesthetics combined with opioids to minimize motor block while providing effective pain relief 1, 2
• Combined spinal-epidural (CSE): Provides rapid onset analgesia with the flexibility of a catheter for extended labor 1
• Single-injection spinal analgesia: Time-limited option when spontaneous vaginal delivery is anticipated 1

When to Initiate Labor Analgesia

Neuraxial analgesia should be offered on an individualized basis regardless of cervical dilation 1. The outdated practice of waiting until a certain dilation (e.g., 5 cm) is no longer recommended 1.

• Patients in early labor (less than 5 cm dilation) should be provided the option of neuraxial analgesia when available 1
• Early insertion of a neuraxial catheter should be considered for complicated pregnancies including twin gestation, preeclampsia, anticipated difficult airway, or obesity to reduce the need for general anesthesia if emergent procedures become necessary 1
• Neuraxial analgesia does not increase the incidence of cesarean delivery 1

Alternative Systemic Analgesia Options

When neuraxial techniques are unavailable, refused, or contraindicated, systemic analgesia may be used, though it is less effective 3:

• Nitrous oxide (inhalation): Should be avoided in women with opioid use disorder as it may be less effective and increases sedation risk 4
• Parenteral opioids: Include morphine, fentanyl, or hydromorphone, though these provide inferior pain relief compared to neuraxial methods and carry risk of maternal and neonatal respiratory depression 3, 5
• Opioid agonist-antagonists (nalbuphine, butorphanol): Strictly contraindicated in women on medication-assisted therapy as they precipitate acute opioid withdrawal 4

Critical Pitfalls to Avoid

Never discontinue medication-assisted therapy (methadone or buprenorphine) during labor in opioid-dependent women, as this risks maternal withdrawal and fetal harm 4. These patients require continuation of their baseline MAT throughout labor and delivery 1, 4.

Avoid administering opioids immediately prior to delivery when possible, as they cross the placenta and may produce respiratory depression in neonates requiring naloxone reversal 6. Hydromorphone and other opioids are specifically not recommended for use immediately prior to labor when other analgesic techniques are more appropriate 6.

Do not use mixed agonist-antagonist opioids (nalbuphine, butorphanol) in women maintained on methadone or buprenorphine, as this will precipitate withdrawal 1, 4.

Postpartum Pain Management

After delivery, the approach differs based on delivery mode:

• Vaginal delivery: Start with scheduled acetaminophen (975 mg every 8 hours or 650 mg every 6 hours) and ibuprofen (600 mg every 6 hours), reserving short-course opioids (hydrocodone 5 mg, limited to 5-10 tablets total) only for severe pain 2
• Cesarean delivery: Multimodal approach including neuraxial morphine (50-100 μg intrathecal or 2-3 mg epidural), scheduled acetaminophen and NSAIDs, with short-course oxycodone only if pain is poorly controlled 2

Severe pain after vaginal delivery is unusual and should prompt evaluation for unrecognized complications such as hematoma or infection 2.