Pain Management and Pregnancy

[jwalker12]

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What are you all offering for pregnant patient's? Are TPI's safe? I am reading even tylenol is now something suggested to be avoided. Looking forward to hearing some responses as for some reason I have been seeing a few more pregnant patients thatI would like. thanks

Tylenol article:

Paracetamol use during pregnancy — a call for precautionary action - Nature Reviews Endocrinology

A growing body of research suggests that prenatal exposure to paracetamol (APAP) might alter development and increase the risk of some reproductive, urogenital and neurodevelopmental disorders. This Consensus Statement calls for precautionary action, including a focused research effort...

www.nature.com

 

[gaspasser127]

There are some reports of teratogenicity associated with local Anesthetics even. why risk it at all when you could be on the hook for the next 18 years?

 

[bedrock]

I don’t see pregnant patients period. They have to just deal with it, and they can thank the blood sucking lawyers.

 

[jwalker12]

Got it. Only reason I ask is because from some dental literature I read, it appears they ok the use of LA's for their procedures during pregnancy.

 

[gaspasser127]

Got it. Only reason I ask is because from some dental literature I read, it appears they ok the use of LA's for their procedures during pregnancy.

If a pregnant lady needs a root canal.. then i don’t think that’s something that can really wait. A pregnant lady doesn’t NEED trigger point injections… or most anything else we do.

 

[Pain Applicant1]

I don't see them either and return them to their OB. My suboxone pts get changed to straight buprenorphine but even that is probably not necessary.

 

[SSdoc33]

you can do TPIs with lido. c'mon, now.

will it help? probably not, but its plenty safe

 

[Baron Samedi]

you can do TPIs with lido. c'mon, now.

will it help? probably not, but its plenty safe

Agreed. There's plenty you can do, even if its not our normal treatment algorithm.

- education and discussing their imaging and prognosis
- discussing lifestyle modifications and exercise
- discussing medication options for s/p delivery and/or nursing and presenting them as future options
- counseling them on medications to avoid
- dry needling or trigger point injections
- discussing inversion tables, SI belts

I've done ultrasound guided peripheral joint, caudal ESI, and SIJ injections for pregnant patients before. A few of my anesthesia colleagues have done landmark-guided ESIs. Its less risky than a labrum repair or a discectomy.

If you only see the role of Pain Management Physicians as needle drivers then, sure, you have nothing to offer. I like to think we have some expertise other than putting the needle in the spot.

 

[drrosenrosen]

I saw a pt during fellowship, inpatient consult. She had been on oral opioids before becoming pregnant. Her PCP/OB placed a PICC line and had her coming into the office daily for IV dilaudid injections. After delivering her, they immediately consulted pain to help them deal with the disaster they had created.

 

[jwalker12]

I saw a pt during fellowship, inpatient consult. She had been on oral opioids before becoming pregnant. Her PCP/OB placed a PICC line and had her coming into the office daily for IV dilaudid injections. After delivering her, they immediately consulted pain to help them deal with the disaster they had created.

That is just crazy