2026 SOAP Annual Meeting

Slide 1 - background

-Antepartum maternal opioid use rates rising1

-Requires multimodal pain control strategy2

-Medication-assisted treatment (MAT) during pregnancy

Slide 2 - case presentation

Initial presentation:

-36 yo G8P4 with vaginal bleeding

-US concerning for Placenta Accreta Spectrum (PAS)

-Polysubstance Use Disorder (methadone 320mg daily)

Intraoperative Management

-Goals: manage hemorrhage, post op pain control

-2x 16g PIV, preinduction arterial line

-Thoracic (T9) epidural catheter with lumbar CSE

-QBL 2095 ml (5upRBC, 2uFFP, 510cc cell saver)

Postop Management

-Thoracic epidural, dPCA, ketamine gtt, Tylenol, Toradol

-Methadone with dose adjustment

-POD1: transitioned to B/L rectus sheath catheters

-POD7: Discharged on PO pain medication

Slide 3 - discussion

-Complexity of postoperative care management in patients with PAS and severe opioid tolerance

-Goal of double epidural technique, and dynamic nature of pain control3,4

-Adjustments to MAT

-Use of dexmedetomidine as alternative to morphine5

Multimodal Analgesia for Postoperative Pain Control in Patient with Opioid Tolerance