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In-hospital oral opioid use after cesarean delivery with neuraxial anesthesia
Abstract Number: T5A-1
Abstract Type: Original Research
Multimodal analgesia after cesarean delivery (CD) is encouraged to reduce systemic opioid use both in hospital and after discharge.(1) There is currently much debate surrounding whether or not oral opioids should even be prescribed after a CD,(2) given short term side effects and potential risk for persistent opioid use after discharge.(3) Our study sought to assess patient, anesthesia, and obstetric characteristics influencing oral opioid use during the first 72 hours after CD with neuraxial anesthesia.
All consecutive CDs conducted with neuraxial anesthesia between January-April 2017 were included in this retrospective study. In the OR, neuraxial morphine (spinal 150-200mcg or epidural 3mg) and ketorolac IV 30mg (unless CI) are given. Postoperatively, scheduled q6h NSAIDs & acetaminophen 650mg are prescribed. For rescue q4h, acetaminophen 650mg if VAS 1-3, oxycodone 5mg if VAS 4-6, oxycodone 10mg if VAS 7-10 is prn. Patient, anesthesia, CD characteristics were recorded. The outcome was oxycodone use (yes/no) during 72h-hospitalization. Multivariable survival analysis adjusting for confounders used a Cox model.
Among 697 CDs identified, 115 women did not take any oxycodone during the first 72 hours (16.5%). After adjustment for patient (age, BMI, ethnicity, parity, gestational age, preeclampsia), anesthesia, and CD characteristics (BTL, primary, planned, day/night time), we found that only gestational age (preterm ≤ 34 weeks), mode of anesthesia (intrapartum epidural) and hospital (main academic center) were associated with oxycodone intake (Table).
We report here the 'no opioids after CD' rate in a North-American cohort. We found that 1:6 women did not take any oxycodone during their in-hospital stay, which is encouraging since there was no intervention to reduce oral opioid intake.
Intrapartum CD with epidural anesthesia was associated with higher hazard ratio for in-hospital oxycodone use, which may be explained by women being more fatigued after trial of labor (or that epidural versus spinal morphine is less effective).
Last, since oral opioid intake was strongly associated with the hospital setting (more women in our main academic center took oxycodone despite identical order sets in both centers), interventions to promote tailored and judicious opioid prescriptions and intake are needed.
1. Anesthesiol Clin 2017;35:107-24
2. Obstet Gynecol 2017;130:42-6
3. Am J Obstet Gynecol 2016;215:353.e1-353