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Pain Resolution and Opioid Cessation after Childbirth
Abstract Number: F-73
Abstract Type: Original Research
Introduction: Pain resolution after child birth has only been described by assessing pain at specific time points after child birth,1-3 and information regarding longitudinal pattern and characteristics of pain resolution after delivery and discharge from hospital is unavailable. The current study aims to establish norms for pain resolution, opioid use, and functional recovery after childbirth.
Methods: Healthy nulliparous women with singleton pregnancies (gestational age >35 weeks and no fetal co-morbidities) were enrolled in this prospective non-interventional study. Women were approached daily in hospital and then contacted telephonically each day until 1) Pain resolution, 2) Opioid cessation, and 3) Self-assessed functional recovery from delivery. Pain burden was measured as area under the curve (AUC) using pain NRS/days (Figure 1). Pain and functional recovery were compared between vaginal and cesarean deliveries (CD) with a t-test and opioid use was compared using Wilcoxon’s summed rank test. Results are reported as mean +/- SD, median (95% CI), or range as appropriate.
Results: Following vaginal delivery (n=19), 39% of patients required opioid analgesics for 1-3 days. Following CD (n=11), all patients required opioids for analgesia for 2-9 days. Patients reported being pain-free 15 ±10, and 18 ± 5 days after vaginal and CD, respectively (P=0.39). AUC for pain days were 29 ± 29 for vaginal, and 44 ± 14 for CD (P=0.23; Figure 1). Opioids were required for 5 (3-6) days longer after CD compared to vaginal delivery (P<0.0001). Functional recovery was attained 19 ±13, and 25 ± 12 days after vaginal and CD, respectively (P=0.30).
Conclusion: We have demonstrated substantial inter-subject variability in pain and functional recovery after both vaginal and CD that is not accompanied by prolonged requirement for opioid analgesia. We did not observe clinically or statistically significant differences in times taken for pain-free recovery and functional recovery between vaginal and CD despite the fact that these recovery periods are considered differently by insurers and employers of parturients. The study also highlights the importance of looking beyond the hospital stay, the usual endpoint of studies, to obtain a true assessment of pain resolution and recovery.
1. Anesthesiology 2013;118:143-51.
2. Birth 2008;35:16-24.
3. Acta anaesthesiologica Scandinavica 2004;48:111-6.