Labor Analgesic Intent and the Use of Postpartum Opioids
Abstract Number: T-75
Abstract Type: Original Research
Introduction: Many studies have attempted to identify factors predictive of post-operative analgesic consumption. For example, type of surgery, patient age, and preoperative anxiety may predict postoperative analgesic use.(1) Unfortunately, little is understood about postpartum pain patterns. Some studies have attempted to identify predictors of postpartum pain after cesarean delivery;(2, 3) however, predictors of postpartum pain after vaginal delivery remain poorly characterized. This preliminary study aims to better characterize predictors of opioid use in the postpartum period after vaginal delivery. We hypothesized that nulliparous women who anticipated and ultimately received neuraxial labor analgesia would be more likely to use any opioid-based analgesic in the postpartum period compared to nulliparous women who did not anticipate or receive neuraxial labor analgesia.
Methods: Retrospective cross-sectional study. Electronic medical record data on all index vaginal deliveries over a 3-year period at Northwestern Memorial Hospital were extracted. On admission, patients self-identified their race/ethnicity, marital status, and anticipated analgesic use for labor. Extracted data included age, race/ethnicity, primary language, insurance status, gravidity, anticipated labor analgesic use and postpartum analgesic use. Patients were categorized into four groups based on anticipated and actual use of neuraxial labor analgesia. The primary outcome was the postpartum use of any opioid-based analgesics. We conducted initial bivariate analyses and estimated a multivariable logistic regression model of postpartum analgesic use after univariate selection using a P<0.1 for model entry.
Results: A total of 9,030 patients were included in the analysis. After controlling for confounding variables, women who did not anticipate or use neuraxial labor analgesia were less likely to use any opioid-based analgesics in the postpartum period than women who anticipated and used neuraxial labor analgesia (adjusted odds ratio [aOR] 0.44, 95% CI: 0.38 to 0.52). Women of Asian ethnicity were less likely to use postpartum opioids (aOR 0.79, 95% CI: 0.65 to 0.96), while women over 35 years of age were more likely (aOR 1.21, 95% CI: 1.11 to 1.33), after controlling for confounders.
Conclusions: Nulliparous women who anticipate and ultimately use neuraxial labor analgesia are more likely to use postpartum opioid-based analgesics compared to nulliparous women who did not anticipate and did not use neuraxial labor analgesia. These findings suggest that analgesic intent may influence postpartum analgesic consumption. Future work should validate this association.
1. Anesthesiology 2009; 111:657–77
2. Acta Anaesthesiol Scand 2007; 51: 582–586
3. Anesthesiology 2013; 118:1170-9