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Postpartum Analgesic Use After Uncomplicated Vaginal Deliveries
Abstract Number: S2B-2
Abstract Type: Original Research
Introduction: Labor is considered to be one of the most painful experiences a woman will encounter in her lifetime. Opioids are commonly prescribed for treatment of pain; however, their use and misuse, has increased dramatically. The Centers for Disease Control, in its recently published guidelines for prescribing opioids for chronic pain, recognized the importance of acute pain management as a strategy for reducing the development of chronic pain and future opioid dependence. To date, the use of opioid analgesics following uncomplicated vaginal deliveries has not been described. The objective of this study was to characterize the use of postpartum analgesics among a cohort of nulliparous women with an uncomplicated vaginal delivery.
Methods: This retrospective, single-institution, cross-sectional study evaluated electronic medical record data for a preexisting dataset of all nulliparous women who had had a spontaneous vaginal delivery between January 1, 2007 and December 3, 2015. Patients who delivered via cesarean or instrumental vaginal delivery were excluded from the analysis. Extracted data included patient demographics, obstetric characteristics, as well as anticipated and actual labor analgesic use. Postpartum analgesic medication use for the 48 hours following delivery was also extracted from the EMR. Opioid analgesics were converted into morphine equivalents and high-morphine use was defined as >91 morphine milligram equivalents in 48 hours. Data were stratified by high- versus low/no morphine use. Categorical data were compared using the chi-squared test. Normal distribution for continuous variables was determined using the Shapiro–Wilk test. Continuous data were compared using the Mann-Whitney test. Data were analyzed using Stata SE (Version 12, College Station, TX).
Results: A total of 35,556 women delivered during the study period. A total of 18,648 women (52%) used an opioid-based medication during the first 48-hours postpartum. Eighteen percent of women received an opioid as the first analgesic drug administered. Ibuprofen was administered as the first analgesic in 67% of women and acetaminophen in 15% of women. Thirteen percent of women (n=2,349) were high-morphine users. High-morphine users were more likely to be older, English-speaking, married, and have planned to use epidural analgesia for labor compared to low/non-morphine users. There was no difference in postpartum acetaminophen use between high- and low/no morphine users (P=0.19); however, high-morphine users used more 48-hr Ibuprofen (4800 vs. 4200 mg, P=0.0001).
Conclusions: Over half of nulliparous women with an uncomplicated vaginal delivery receive an opioid-based analgesic postpartum, with 18% of women receiving an opioid as their first administered analgesic. Many women are opioid naïve prior to delivery; therefore strategies to maximize postpartum non-opioid analgesics may reduce long-term postpartum opioid use.