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Total oral oxycodone intake after cesarean delivery according to clinical scenario
Abstract Number: T5A-4
Abstract Type: Original Research
Multimodal analgesia to reduce opioid use and provide enhanced recovery is considered the 'gold-standard' after cesarean delivery (CD). However, few studies have examined whether the clinical scenario leading to the CD (e.g. intrapartum vs scheduled, primary vs repeat, day vs night) influences analgesic use. Therefore, while computerized physician order entry (CPOE) has ensured standardized post-CD orders in recent years, tailoring analgesic regimens accounting for the specific clinical scenario is not standard practice. Our goal was to assess the total in-hospital oxycodone (OXY) intake after all CDs under neuraxial anesthesia, and potentially identify patterns that may allow better tailoring of opioid prescriptions in the future.
All CDs between Jan-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) were given. CPOE entailed: scheduled q6h NSAIDs & acetaminophen 650mg; for rescue q4h prn, acetaminophen 650mg if VAS 1-3, OXY 5mg if VAS 4-6, OXY 10mg if VAS 7-10. Outcomes included total OXY dose, timing of first OXY dose, total acetaminophen dose. Descriptive statistics were applied.
We identified 504 CDs under neuraxial anesthesia, of which 323 primary CDs (64%), 275 day-time CDs (54.6%), and 171 CDs with epidurals placed intrapartum (33.9%) (Table). Overall, mean OXY dose was 63±54mg, with 48 women not taking any OXY (9.5%). Mean time to 1st OXY tablet was 1071±859min. There were 35 women not taking any acetaminophen (6.9%), and mean acetaminophen dose was 4571±3256mg for the entire hospitalization. Mean OXY use was 67±56.0mg in primary CDs vs 59±50.4mg in repeat CDs (p=0.10). Comparisons between spinal/CSE in OR vs epidural catheter used for CD, day vs night time did not show any statistically significant differences (Table).
In this cohort of consecutive cases in one single center with standardized post-cesarean pain orders, we did not find any variations in OXY use during the in-hospital stay following a CD irrespective of clinical scenario. We anticipated significantly lower opioid use after scheduled day-time CDs occurring as planned, in contrast with that after night-time intrapartum CDs following long trials of labor; this was not the case. Further evaluations are needed to examine how, why and when women take pain medicines, particularly since we noted that acetaminophen was not taken as prescribed.