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Outpatient Opioid Use after Multimodal Pain Management for Cesarean Delivery: A Randomized Control Trial
Abstract Number: S3B-2
Abstract Type: Original Research
Objective: Opioid misuse/addiction may develop following medically-indicated use such as postoperatively. Opioid use while breastfeeding has recently received significant attention. Cesarean delivery (CD) is the most common surgical procedure in the US. We sought to evaluate outpatient opioid use after scheduled CD.
Study Design: Ancillary study of a single center trial of perioperative pain control for elective CD. Participants were allocated 1:1 to receive IV Tylenol, SC bupivacaine, and IM ketorolac (study group) or matching placebos. Postoperative pain management was per standard of care and patients were discharged with 30 tablets of Tylenol #3. Patients were contacted on postoperative day (POD) 7 to determine their outpatient opioid use and chart was reviewed at 1 month to determine neonatal outcomes. Primary outcome for this analysis was percent of discharge opioid medications left on POD 7. Parametric and non-parametric statistical tests and quantile regression were used for analysis.
Results: POD 7 data was obtained from 115/120 (95.8 %) of women enrolled in the parent trial. Baseline characteristics, CD indications, and inpatient opioid use was similar between study and placebo groups. Overall, patients had 18 (IQR 12-24) opioid tablets remaining on POD 7, which was 60% (IQR 37-80%) of the tablets prescribed. There was no significant difference in the percent of opioids remaining POD 7 between the two groups (Table). There was no difference in pain or satisfaction scores between the groups, but increasing opioid intake was inversely correlated with satisfaction scores (-0.3, p=0.001). The quantile regression coefficients showed that median MME used after discharge positively correlated with inpatient opioid use (0.91 MME, 95% CI 0.5-1.3, p<0.001), and inversely with maternal obesity (-23 MME, 95% CI -38.4 - -7.6, p=0.02). There was no correlation between the amount of maternal opioid intake in the first week postpartum and neonatal outcomes up to one month of life.
Conclusion: A multimodal pain regimen did not alter the amount of outpatient opioid use after scheduled CD. On average, patients used less than half of opioid tablets prescribed and the amount of opioid medications used negatively correlated with their satisfaction. Individualizing the amount of outpatient opioids prescribed after CD may prevent leftover opioids and help curb the US opioid epidemic.