Objective To define the amount of opioid analgesics prescribed and consumed after discharge after cesarean delivery. Methods We conducted a survey at six academic medical centers in the United States from 9/2014 to 3/2016. Women who had undergone a cesarean delivery were contacted by phone two weeks after discharge and participated in a structured interview about the opioid prescription they received upon discharge and their oral opioid intake while at home. Results A total of 720 women were enrolled; of these, 615 (85.4%) filled an opioid prescription. The median number of dispensed opioid tablets was 40 (interquartile range (IQR) 30 to 40), the median number consumed was 20 (IQR 8 to 30), and leftover was 15 (IQR 3 to 26). Of those with leftover opioids, 95.3% had not disposed of the excess medication at the time of the interview. There was an association between a larger number of tablets dispensed and the number consumed independent of patient characteristics. The amount of opioids dispensed did not correlate with patient satisfaction, pain control, or the need to refill the opioid prescription. Conclusion The amount of opioid prescribed after cesarean delivery generally exceeds the amount consumed by a significant margin, leading to substantial amounts of leftover opioid medication. Lower opioid prescription correlates with lower consumption without a concomitant increase in pain scores or satisfaction.

Objective To assess whether a shared decision-making intervention decreases the quantity of oxycodone tablets prescribed after cesarean delivery. Technique A tablet computer-based decision aid formed the basis of a shared decision-making session to guide opioid prescribing after cesarean delivery. Women first received information on typical trajectories of pain resolution and expected opioid use after cesarean delivery, and then chose the number of tablets of oxycodone 5mg they would be prescribed, up to the institutional standard prescription of 40 tablets. Experience From April 11, 2016, to June 10, 2016, 105 women were screened, 75 were eligible, and 51 consented to participate; one patient was excluded after enrollment due to prolonged hospitalization. The median number of tablets (oxycodone 5 mg) women chose for their prescription was 20.0 [interquartile range of 15.0, 25.0], which was less than the standard 40-tablet prescription (p<0.001). Conclusion A shared decision-making approach to opioid prescribing after cesarean delivery was associated with approximately a 50% decrease in the number of opioids prescribed postoperatively in this cohort compared with our institutional standard prescription. This approach is a promising strategy to reduce the amount of leftover opioid medication after treatment of acute postcesarean pain. Clinical Trial Registration NCT02770612 at clinicaltrials.gov