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Split doses of oral opioids significantly reduced opioid consumption and related side-effects after cesarean delivery
Abstract Number: F3A-50
Abstract Type: Original Research
Background: Despite multimodal analgesia, most women require opioids for breakthrough pain after cesarean delivery (CD). Opioids are associated with opioid-related side effects (including postoperative nausea and vomiting (PONV), pruritis, and respiratory depression), persistent opioid use after surgery, and drug transfer in breastmilk. The aim of this study was to evaluate the impact of a novel postoperative analgesic order-set that we introduced in an effort to reduce opioid consumption.
Methods: This retrospective impact study reviewed electronic medical record data before and after implementation of a new order-set for cesarean delivery performed under neuraxial anesthesia. Oxycodone orders changed from 5 mg (for verbal pain score ≤4/10) and 10 mg (for 5-10/10) to 2.5 mg (for verbal pain score 1-4/10) or 5 mg (for 5-10/10) with a registered nurse check within 1 hour following administration to administer another 2.5 mg or 5 mg respectively if needed. The primary outcome was opioid use in the first 48 hours. Secondary outcomes included incidence and treatment of PONV and pruritis, and verbal pain scores (average and peak) 0-48 h after cesarean delivery.
Results: 1050 women were evaluated (542 before and 508 after the change). Opioid use in the first 48 hours was significantly lower in the post-practice change group (median [interquartile range] 10.0 [1.3-25.0] mg before vs. 4.4 [0-12.5] mg after split dosing was introduced; P<0.001, Fig 1A). There was a small increase in average verbal pain score occurred (mean (standard deviation) 1.8 (1.0) before vs. 2.0 (1.3) after; P=0.01), but no difference in peak verbal pain score (5.9 (2.0) before vs. 6.0 (2.1) after; P=0.23). PONV was significantly reduced in the post-practice change group (30.9% before vs. 19.3% after; P<0.001, Fig 1B).
Conclusions: This study of over 1000 patients found that splitting doses of oxycodone and allowing the patient to receive the remainder of the dose 1 hour later reduced 48-hour opioid use by over 50% and reduced opioid-related PONV after CD. This simple, patient-centered, opioid-reduction strategy did not compromise pain relief and should be further investigated and adopted in obstetric practices to reduce postpartum opioid consumption.
1. Anesth Analg. 2012;115(3):694–702
2. Obstet Gynecol. 2017;130(1):29–35
3. Best Pract Res Clin Anaesthesiol. 2017;31(1):69–79