Management of Pain During Maternal Critical Illness

There are numerous painful circumstances that require optimal management in the critically ill obstetric patient; indeed untreated pain may hamper a women’s ability to maintain adequate oxygenation and perfusion for the mother and the fetus. Therefore, management of pain in the context of acute critical medical conditions (e.g., acute pancreatitis), in the context of trauma (e.g., fractured ribs), or after abdominal surgery are even more crucial in the critically ill pregnant population. Optimizing pain management with regional or neuraxial medications is preferable over systemic medications in order to minimize in utero fetal exposure. Often, a combined analgesia regimen that includes regional and systemic medications provides the best result for pain management. A multidisciplinary team that includes anesthesiologists, intensivists, neonatologists, and obstetricians should collaborate to create a tailored pain management plan.