A multimodal approach to reducing post‐caesarean opioid use: a quality improvement initiative

Abstract

Population: Women over 18 years undergoing caesarean section.Methods: A quality improvement (QI) initiative titled Reduced Option for Opioid Therapy (ROOT) was implemented in women undergoing caesarean section. The intervention included implementation of a postpartum order set maximising the use of scheduled NSAIDs and acetaminophen. Additionally, nursing education promoted non-opioid therapy as first-line, with opioids reserved for breakthrough pain. Performance feedback was provided to nursing staff on a bimonthly basis. Postcaesarean opioid use was reviewed in the 6 months before and after implementation of ROOT. Main outcome measures:The primary outcome was the total morphine milligram equivalents (MME) consumed during the postpartum admission. Secondary outcomes included opioid use per postoperative day, the proportion of opioid-free admissions, the percentage of patients discharged with a prescription for opioids, prescription size, and pain scores.Results: Following implementation of ROOT, median inpatient opioid use decreased by more than 60%, from 75 to 30 MME per admission (P < 0.001). The proportion of opioid-free admissions increased from 12.6% pre-intervention to 30.7% postintervention (P < 0.001). Additionally, the median opioid dose prescribed at discharge decreased in the post-intervention cohort, and the proportion of patients discharged without an opioid prescription increased. The reduction in opioids was associated with a slight decrease in patient-reported pain scores.Conclusions: Implementation of ROOT significantly reduced opioid use while achieving comparable pain control.

Analgesia after cesarean section – what is new?

“…The PROSPECT guidelines, therefore, recommend intravenous NSAIDs intra- as well as postoperatively. A fixed postoperative regimen of paracetamol and NSAIDs is preferable [22 ▪ ,23 ▪ ].…”