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Factors associated with the non-use of oxycodone after cesarean delivery under neuraxial anesthesia
Abstract Number: F3A-205
Abstract Type: Original Research
Reducing the amount of opioids taken after cesarean delivery (CD) is now the recommended strategy to lower the risk of maternal complications, breastfed newborn sedation, persistent opioid use, misuse and diversion. No routine opioid prescription after CD is even proposed.(1) We decided to examine factors that may be associated with women not taking any oxycodone during their hospital stay after CD, which may guide more tailored approaches in our institution.
Women undergoing CD with neuraxial anesthesia from Jan-Sept 2018 were identified through electronic anesthesia records. Patient characteristics, obstetric, surgical and anesthesia data were collected. Primary outcome was ‘non-use of oxycodone’ (NUO) during the entire hospital stay (up to 80h). Anesthesia protocol includes neuraxial morphine (150mcg IT or 3mg epidural), IV ketorolac 30mg at end of case (unless CI), followed by standard q6h acetaminophen 975mg, ibuprofen 600mg. Oxycodone 5mg prn is only given for moderate (q4h) to severe (q3h) pain with a maximum daily dose of 30mg. Univariable and multivariable analysis was applied.
After excluding 80 cases (4.7%; GA, complicated surgery or prolonged hospital stay), 1635 cases were analyzed. The number of women not taking any oral oxycodone (or other systemic opioid) was 537 (32.8%). Factors associated with NUO were (Table): adherence to order sets, delivery in satellite hospital, lower BMI, being Asian, delivery ≥39 weeks, and no tubal ligation. Intrapartum CD with epidural labor analgesia >20h was associated with decreased odds for NUO (adjusted OR 0.502; p=0.004).
Recent strategies to reduce in-hospital opioid use have resulted in our finding of 1:3 women not taking oxycodone after CD. We were previously not able to identify factors associated with NUO since the ratio was only 1:10. Our finding that 20% of women were not taking the non-opioid analgesics as prescribed (non-adherence to order sets), which resulted in higher odds for oxycodone intake, warrants further nursing education and patient information on the risks/benefits associated with postoperative opioid use. Our data otherwise confirms some of the factors thought to increase opioid use (tubal ligation), but higher BMI was not expected to significantly increase opioid use. Another important and yet unreported association was prolonged intrapartum CD (> 20h) which reduced the odds for NUO.
1. Obstet Gynecol 2019;133:91-7