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Rates of opioid prescribing are at historically high levels, and, as opioid exposure increases, the number of women of childbearing age with opioid use disorder is rising. Despite this growing population, the optimal management of pain for parturients maintained on medical-assisted therapy (MAT, i.e., methadone or buprenorphine) is unknown. This systematic review is intended to evaluate patient outcomes associated with pain management strategies for parturients on MAT. Literature databases EMBASE, MEDLINE, and the Cochrane Library were searched up to September 2017. Articles were included if they discussed peripartum analgesic options for pregnant women with opioid dependence. The search identified 1,814 articles, of which, nine matched all inclusion criteria and were selected for data extraction and analysis. Articles were a mix of case series, retrospective case reviews, retrospective cohorts, and randomized controlled trials. They showed various responses ranging from no difference in analgesic requirements between MAT and non-MAT patients to MAT patients requiring higher amounts of opioids after a cesarean section. Parturients on MAT present a number of challenges for obstetric anesthesiologists, but various approaches can be used to achieve satisfactory analgesia. It is important to practice an individualized yet multidisciplinary approach to ensure the delivery of optimal patient care. [ABSTRACT FROM AUTHOR]

In the United States, the prevalence of pregnancy-related deaths has risen significantly over the past 20 years. Pregnant women at high risk for peripartum complications should undergo anesthesia consultation before delivery so that a management plan can be created between the obstetrician, anesthesiologist, and patient to ensure optimal outcomes for both the mother and newborn. However, few hospitals outside of major, urban, academic medical centers have dedicated anesthesiologists specially trained in obstetric anesthesia and the resources available to expedite optimization of high-risk parturient comorbidities. Telemedicine is a valuable tool by which evaluation, triaging, and multidisciplinary coordination can be provided for high-risk obstetric patients living in remote or rural communities without access to specialized, maternal care medical facilities. This review examines the existing literature regarding telemedicine use in preoperative anesthesia and antenatal obstetrics and identifies areas for future research. Furthermore, the benefits and potential barriers of implementing a telemedicine program specifically dedicated to obstetric anesthesia are discussed.