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Postoperative Opioid Consumption after Intrapartum Cesarean Deliveries: The Effect of Repeat Cesarean Delivery
Abstract Number: F3C-236
Abstract Type: Original Research
Pain after cesarean delivery (CD) is referred to as one entity but circumstances of CD may influence postoperative pain and analgesic use. Unplanned intrapartum CD may be associated with increased postoperative opioid use,1 and repeat CD may result in increased pain secondary to central hypersensitization from previous surgery.2 The combined effects of labor and a previous uterine scar on analgesic use after a subsequent CD have not been examined. To test the hypothesis that repeat CD in the setting of uterine contractions triggers increased nociception, we compared postoperative oxycodone use in women undergoing repeat intrapartum CD (failed TOLAC) with women having a primary intrapartum CD.
All women receiving intrapartum epidural analgesia converted to anesthesia for CD between Jan-Sept 2018 were included in this retrospective analysis. Epidural anesthesia for CD and postoperative analgesia were standardized according to institutional anesthesia protocols and postoperative order set. Demographic and obstetrical factors were recorded. Primary outcome was non-use of oxycodone during hospital stay; secondary outcomes were total oxycodone dose and time to 1st oxycodone dose. Descriptive statistics were applied to compare the 2 groups (failed TOLAC vs intrapartum primary CD), with estimation of adjusted risk of opioid use using regression models.
After exclusion of CDs under GA ± replaced neuraxial anaesthesia (N=59), there were 32 failed TOLAC (6%) of 529 intrapartum CD. Duration of labor was significantly shorter in failed TOLAC group (Table). Using univariate analysis, there was no statistically significant difference in proportion of women not taking oxycodone during hospital stay or total oxycodone dose (Table); after adjusting for maternal age, parity, gestational age, duration of labor before CD, night time and tubal ligation, total oxycodone dose was lower in failed TOLAC group (Table).
After adjusting for confounders (including duration of labor), oxycodone consumption was lower in women with failed TOLAC, which is contrary to our expectation. Since oxytocin-induced endogenous analgesia occurred in both cohorts, we are not sure how to explain this finding. We acknowledge that the proportion of women with failed TOLAC was low and that additional evaluation of the effect of labor with or without a previous CD in larger cohorts is needed.
1. Obstet Gynecol 2019;133:354–63
2. Eur J Pain 2013;17:111-23