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Factors associated with early oral oxycodone use after cesarean delivery with neuraxial anesthesia
Abstract Number: T5A-3
Abstract Type: Original Research
Post-cesarean pain has been the focus of much research to improve maternal experience and enhance recovery (1).
Current analgesic protocols include neuraxial opioids, followed by multimodal analgesic medications based on pain scores assessment.
A better understanding of factors associated with oral opioid use after cesarean delivery (CD) may reduce their consumption.
To identify patterns of early opioid intake after CD, we assessed the timing of 1st oral opioid use, expecting none in the 1st 6 hours.
All consecutive CDs conducted 01-04/2017 in our academic Center (C) & satellite Annex (A) were included in this retrospective study, with same postoperative pain orders in both hospitals.
In the OR, neuraxial morphine and ketorolac IV 30mg (unless CI) are given. Scheduled q6h NSAIDs & acetaminophen 650mg are prescribed. For rescue q4h per-need, acetaminophen 650mg if VAS 1-3, oxycodone 5mg if VAS 4-6, oxycodone 10mg if VAS 7-10. Demographic & obstetric data were recorded. Type of anesthesia (spinal, CSE in OR, intrapartum epidural catheter, neuraxial clonidine as adjuvant) and time of CD (day 8am-5pm vs night 5pm-8am) were noted. The outcome was survival without oxycodone at 6h after CD (defined as delivery time). Multivariable survival analysis adjusting for confounders used a Cox model.
Among 728 CDs identified, 31 GA cases were excluded. There were 491 cases at C and 206 at A (29.6%).
Oxycodone use at 6h occurred in 164/697 cases (23.5%). After adjustment for patient factors (age, BMI, ethnicity, parity, gestational age, preeclampsia), anesthesia factors (type, clonidine given in 81 cases) and CD characteristics (BTL, primary, planned, day vs night), only the hospital (C vs A) was associated with oxycodone intake (adjusted Hazard Ratio 2.20; 95% CI 1.47-3.31; P<0.001; Figure).
To our surprise, the only factor associated with early oxycodone use was the hospital where the CD was performed.
Despite having the exact same order sets in both locations, women in our main academic center (hospital C) were twice more likely to take oxycodone. Since we adjusted for all possible confounders, we interpret our finding to be related to the way pain medications (pills) are given to women ('nurse-patient interaction' effect). This raises questions about how order sets are interpreted and applied, and urges us to rethink provider and patient education, while promoting judicious opioid use.
1. Anesthesiol Clin 2017;35:107-24