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Multimodal analgesia after cesarean delivery: how well are we doing?
Abstract Number: F3C-234
Abstract Type: Original Research
Cesarean delivery is the most common inpatient procedure in the U.S. with a remarkably high opioid intake and prescription volume.1 The number of publications reporting on the opioid crisis in the U.S. in both the lay press and medical journals has escalated in the last years and data on prescribed opioid overdoses are alarming.2 We hypothesized that with this abundance of information, providers and patients are highly aware of issues surrounding opioid use, which will impact opioid intake after cesarean delivery. We therefore decided to examine non-opioid and opioid intake after CD during 2 epochs 12 months apart, expecting a decrease in opioid use in 2018 compared with that in 2017.
Data from all consecutive CDs under neuraxial anesthesia in Jan-Feb 2017 and Jan-Feb 2018 was collected retrospectively in our hospital (academic hospital with ~6,800 deliveries per year, CD rate of 30%). There was no change in obstetric or anesthesia practice, nor in pain order sets (see Table). All women receive neuraxial morphine (spinal dose = 150 mcg; epidural dose = 3mg). Comparisons between the 2 epochs included total in hospital paracetamol, ibuprofen/ketorolac doses, total in-hospital oxycodone dose (mg), time from CD to 1st oxycodone dose, the number of women not taking any oxycodone/percocet in hospital (Table).
Our analysis included 239 CDs in 2017 and 218 CDs in 2018. Demographic data was similar in both epochs (Table).
There was no difference in non-opioid or opioid doses between the 2 epochs. A vast majority of women took oxycodone (over 95% in both epochs) and the median cumulative dose of oxycodone was unchanged at 70mg.
Our data suggests that despite ample media coverage about risks associated high opioid use, particularly in a breastfeeding population, opioid intake in our hospital did not decrease between 2017 and 2018. While this may appear as a ‘natural experiment’ with no intervention, our intention was to demonstrate that standardized order sets, providers education and patient information are necessary to reduce in-hospital opioid use. Since our providers believe that our protocols are promoting multimodal analgesia as recommended by ACOG and SOAP, this data should serve as the basis to implement more standardized opioid-sparing approaches.
1. Bateman, Obstet Gynecol 2017;130:29-35