Home opioid use following cesarean delivery: How many opioid tablets should obstetricians prescribe?

Schmidt, Payton; Berger, Mitchell B.; Day, Lori; Swenson, Carolyn W.

doi:10.1111/jog.13579

Cited by 22 publications

(27 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…These values compare with a top quartile of 202.5 MMEs for the entire sample in our study. The higher amount of cumulative opioids reported taken in the study by Schmidt et al 33 may be related to the fact that this study was the oldest (data collected from 2015-2016) and opioid prescription amounts have been down-trending in recent years. Evidence-based guidelines have been shown to reduce the degree of overprescribing in the postoperative setting.…”

Section: Discussion Key Findingsmentioning

confidence: 69%

“…They found, however, that only top-quartile opioid users took more MMEs per hour of inpatient stay than "average" opioid users. The top quartiles of cumulative postdischarge opioid use in the aforementioned studies were 45 opioid tablets 33 and 200 MMEs, 16 respectively. These values compare with a top quartile of 202.5 MMEs for the entire sample in our study.…”

Section: Discussion Key Findingsmentioning

confidence: 92%

“…Other recent studies have attempted to identify factors that may help predict postdischarge opioid use in patients having a cesarean delivery. In a retrospective cohort study of 141 postcesarean patients, Schmidt et al 33 found that longer operative time and increased number of opioid pills prescribed both independently correlated with top-quartile opioid use after discharge. 33 This finding further enhances the concern about prescribing too many opioids, if in fact patients who receive more also take more.…”

Section: Discussion Key Findingsmentioning

confidence: 99%

“…In a retrospective cohort study of 141 postcesarean patients, Schmidt et al 33 found that longer operative time and increased number of opioid pills prescribed both independently correlated with top-quartile opioid use after discharge. 33 This finding further enhances the concern about prescribing too many opioids, if in fact patients who receive more also take more. In another prospective cohort study of 179 postcesarean patients, Osmundson et al 16 identified tobacco use and predischarge MMEs used as independent predictors of topquartile use after discharge.…”

Section: Discussion Key Findingsmentioning

confidence: 99%

See 3 more Smart Citations

Predicting Opioid Use Following Discharge After Cesarean Delivery

et al. 2020

View full text Add to dashboard Cite

PURPOSE Although cesarean delivery is the most common surgical procedure in the United States, postoperative opioid prescribing varies greatly. We hypothesized that patient characteristics, procedural characteristics, or both would be associated with high vs low opioid use after discharge. This information could help individualize prescriptions. METHODS In this prospective cohort study, we quantified opioid use for 4 weeks following hospital discharge after cesarean delivery. Predischarge characteristics were obtained from health records, and patients self-reported total opioid use postdischarge on weekly questionnaires. Opioid use was quantified in milligram morphine equivalents (MMEs). Binomial and Poisson regression analyses were performed to assess predictors of opioid use after discharge. RESULTS Of the 233 patients starting the study, 203 (87.1%) completed at least 1 questionnaire and were included in analyses (86.3% completed all 4 questionnaires). A total of 113 patients were high users (>75 MMEs) and 90 patients were low users (≤75 MMEs) of opioids postdischarge. The group reporting low opioid use received on average 44% fewer opioids in the 24 hours before discharge compared with the group reporting high opioid use (mean = 33.0 vs 59.3 MMEs, P <.001). Only a minority of patients (11.4% to 15.8%) stored leftover opioids in a locked location, and just 31 patients disposed of leftover opioids. CONCLUSIONS Knowledge of predischarge opioid use can be useful as a tool to inform individualized opioid prescriptions, help optimize nonopioid analgesia, and reduce opioid use. Additional studies are needed to evaluate the impact of implementing such measures on prescribing practices, pain, and functional outcomes.

show abstract

Section: Discussion Key Findingsmentioning

confidence: 69%

Section: Discussion Key Findingsmentioning

confidence: 92%

Section: Discussion Key Findingsmentioning

confidence: 99%

Section: Discussion Key Findingsmentioning

confidence: 99%

See 2 more Smart Citations

Predicting Opioid Use Following Discharge After Cesarean Delivery

et al. 2020

View full text Add to dashboard Cite

show abstract

“…provided to patients not receiving LTOT. Numerous studies report that patients frequently take fewer opioids than prescribed 11,[28][29][30][31]. Therefore, larger amounts of prescribed opioids suggest excess opioids potentially accessible to others, increasing risks of misuse and overdose.…”

mentioning

confidence: 99%

Indication-Specific Opioid Prescribing for US Patients With Medicaid or Private Insurance, 2017

et al. 2020

View full text Add to dashboard Cite

IMPORTANCE Although opioids can be effective medications in certain situations, they are associated with harms, including opioid use disorder and overdose. Studies have revealed unexplained prescribing variation and prescribing mismatched with patient-reported pain for many indications. OBJECTIVE To summarize opioid prescribing frequency, dosages, and durations, stratified across numerous painful medical indications. DESIGN, SETTING, AND PARTICIPANTS Retrospective cross-sectional analysis of 2017 US administrative claims data among outpatient clinical settings, including postsurgical discharge. Participants had any of 41 different indications associated with nonsurgical acute or chronic pain or postsurgical pain or pain associated with sickle cell disease or active cancer and were enrolled in either private insurance (including Medicare Advantage) in the OptumLabs Data Warehouse data set (n = 18 016 259) or Medicaid in the IBM MarketScan Multi-State Medicaid Database (n = 11 453 392).

show abstract

Efficacy of Single Wound Infiltration With Bupivacaine and Adrenaline During Cesarean Delivery for Reduction of Postoperative Pain

et al. 2022

View full text Add to dashboard Cite

ImportanceMost women report moderate to severe pain after cesarean delivery. The extent of the ability of surgical wound infiltration with local anesthetic agents during cesarean delivery for the reduction of postoperative pain is uncertain.ObjectiveTo examine the efficacy of single wound infiltration with bupivacaine and adrenaline during cesarean delivery for the reduction of postoperative pain.Design, Setting, and ParticipantsThis randomized clinical trial was conducted between January 25, 2018, and May 30, 2020, at a university teaching hospital in Afula, Israel. A total of 288 women with singleton pregnancy who were scheduled for a planned cesarean delivery at term were randomized to receive single wound infiltration with bupivacaine and adrenaline during cesarean delivery (intervention group) or no single wound infiltration (control group) at a 1:1 ratio.InterventionsIn the intervention group, the subcutaneous layer was infiltrated on both sides of the wound by a mixture of bupivacaine and adrenaline before wound closure. Other perioperative techniques were similar between the groups.Main Outcomes and MeasuresThe primary outcome was mean pain intensity over the course of 24 hours after the operation, as measured by a visual analog scale (VAS) score ranging from 0 to 10 (with higher scores indicating greater pain intensity). To detect a mean (SD) reduction of 1 (3) points in the VAS score in the intervention group, 286 women were needed in total. Secondary outcomes included VAS score greater than 4 (indicating moderate pain) at 2 hours after the operation, use of rescue opioids, maternal satisfaction with the pain management procedure (using a scale of 1-5, with higher scores indicating greater satisfaction), duration of the operation, scar complications (hematoma, infection, and separation), and length of stay.ResultsAmong 288 women (mean [SD] age, 32.5 [5.1] years; all of Arab or Jewish ethnicity), 143 were randomized to the intervention group, and 145 were randomized to the control group. Demographic and obstetric variables were similar between groups. The primary outcome (VAS pain score) was significantly lower in the intervention group (mean [SD], 2.21 [0.56]) compared with the control group (mean [SD], 2.41 [0.73]; P = .02). In the intervention group, 11 women (7.7%) had a VAS score greater than 4 at 2 hours compared with 22 women (15.2%) in the control group (odds ratio, 0.47; 95% CI, 0.22-1.00; P = .05). In addition, compared with the control group, the intervention group had significantly lower postpartum use of rescue opioid analgesics (19 women [13.3%] vs 37 women [25.5%]; P = .009) and greater satisfaction with pain management (mean [SD] score, 4.65 [0.68] vs 4.44 [0.76]; P = .007). In the intervention vs control groups, duration of the operation, scar complications (hematoma, infection, or separation), and length of stay were comparable.Conclusions and RelevanceIn this study, wound infiltration with a single administration of bupivacaine and adrenaline during cesarean delivery reduced postoperative pain and opioid use and may have improved maternal satisfaction with pain management. These findings suggest the technique is efficacious, safe, and easy to perform.Trial RegistrationClinicalTrials.gov Identifier: NCT03395912

show abstract

Home opioid use following cesarean delivery: How many opioid tablets should obstetricians prescribe?

Abstract: In the first 2 weeks post-partum, 75% of women used 45 or fewer opioid tablets. Operative time over 1 h and increased number of opioid tablets prescribed are factors associated with higher post-partum opioid use.

Cited by 22 publications

References 15 publications

Predicting Opioid Use Following Discharge After Cesarean Delivery

Predicting Opioid Use Following Discharge After Cesarean Delivery

Indication-Specific Opioid Prescribing for US Patients With Medicaid or Private Insurance, 2017

Efficacy of Single Wound Infiltration With Bupivacaine and Adrenaline During Cesarean Delivery for Reduction of Postoperative Pain

Contact Info

Product

Resources

About