Individualized Compared With Standard Postdischarge Oxycodone Prescribing After Cesarean Birth

Osmundson, Sarah S.; Raymond, Britany L.; Kook, Bradley T.; Lam, LeAnn; Thompson, E; Schornack, Leslie A.; Voorhees, Catherine E.; Richardson, Michael G.

doi:10.1097/aog.0000000000002782

Cited by 44 publications

(64 citation statements)

References 12 publications

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“…Individualized prescriptions resulted in a 50% reduction in leftover opioids (14 vs 30 tablets, p<0.001) as well as a 50% reduction in opioid used (8 vs 14 tablets, p<0.001). 36 No differences in patient-reported pain outcomes were found in either study.…”

Section: Opioid Prescribing and Unused Opioidsmentioning

confidence: 71%

Opioid prescribing after childbirth: overprescribing and chronic use

Osmundson¹,

Min

Grijalva

2019

Current Opinion in Obstetrics &Amp; Gynecology

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Purpose of review-Over-prescribing opioids contributes to the epidemic of drug overdoses and deaths in the United States. Opioids are commonly prescribed after childbirth especially after cesarean, the most common major surgery. This review summarizes recent literature on patterns of opioid over-prescribing and consumption after childbirth, the relationship between opioid prescribing and chronic opioid use, and interventions that can help reduce over-prescribing. Recent findings-It is estimated that more than 80% of women fill opioid prescriptions after cesarean birth and about 54% of women after vaginal birth, although these figures vary greatly by geographical location and setting. After opioid prescriptions are filled, the median number of tablets used after cesarean is roughly 10 tablets and the majority of opioids dispensed (median 30 tablets) go unused. The quantity of opioid prescribed influences the quantity of opioid used. The risk of chronic opioid use related to opioid prescribing after birth may seem not high (annual risk: 0.12-0.65%) but the absolute number of women who are exposed to opioids after childbirth and become chronic opioid users every year is very large. Tobacco use, public insurance, and depression are associated with chronic opioid use after childbirth. The risk of chronic opioid use among women who underwent cesarean and received opioids after birth is not different from the risk of women who received opioids after vaginal delivery. Summary-Women are commonly exposed to opioids after birth. This exposure leads to an increased risk of chronic opioid use. Physician and providers should judiciously reduce the amount of opioids prescribed after childbirth, although more research is needed to identify the optimal method to reduce opioid exposure without adversely affecting pain management.

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Section: Opioid Prescribing and Unused Opioidsmentioning

confidence: 71%

Opioid prescribing after childbirth: overprescribing and chronic use

Osmundson¹,

Min

Grijalva

2019

Current Opinion in Obstetrics &Amp; Gynecology

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“…Strategies that have demonstrated promise in this regard include the use of shared decision-making (in which women select the quantity of opioids they want to be prescribed up to a defined limit) 48,49 and individualized prescriptions based on inpatient opioid use. 50 Given the risks and adverse side-effect profile of opioids, some have questioned whether oral opioids should be prescribed routinely for all women after cesarean delivery. Informal survey data suggest that, in most countries aside from the United States and Canada, opioids are rarely or never prescribed to women who have had a cesarean delivery.…”

Section: Pain Management After Cesarean Delivery Among Opioid-naïve Wmentioning

confidence: 99%

Substance use disorders in pregnancy: clinical, ethical, and research imperatives of the opioid epidemic: a report of a joint workshop of the Society for Maternal-Fetal Medicine, American College of Obstetricians and Gynecologists, and American Society of Addiction Medicine

Ecker

Abuhamad

Hill

et al. 2019

American Journal of Obstetrics and Gynecology

121

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“…Osmundson et al compared this approach to a standardized opioid prescription of 30 oxycodone 5 mg pills given to women post cesarean section. 95 Of the 127 women included, those given individualized perscriptions were prescribed less opioids and used half the amount of the opioids prescribed compared to those who were given the standard prescription. Those not needing opioids in hospital were not prescribed any opioids postdischarge.…”

Section: Patients Should Receive a Prescription For Opioid-mentioning

confidence: 99%

“…Those not needing opioids in hospital were not prescribed any opioids postdischarge. 95 Using the final 24 h for prescribing estimation was suggested by Hill et al after analyzing 333 cases of a wide range of operations, including minor procedures such as inguinal hernia repair and major ones such as colon surgery. 96 Hill et al went on to recommend 15 opioid-containing pills for patients using one to three pills, 30 for those using four or more pills, and none for those not requiring any in the 24 h prior to discharge.…”

Section: Patients Should Receive a Prescription For Opioid-mentioning

confidence: 99%

“…Using this model, 4 to 9 days for general surgery procedures, 4 to 13 days for women's health procedures, and 6 to 15 days for musculoskeletal procedures were suggested as the average initial lengths of opioid prescription. 111 With respect to the number of pills to be prescribed, the use of the last 24-h period in hospital to estimate the number of prescribed pills as espoused by Osmundon et al 95 and Hill et al 96 was discussed previously. Theils et al also performed an extensive multicenter analysis on opioid requirements following 25 common surgical procedures, leading to the Mayo Clinic's detailed outline of prescribing low-, standard, and high-dose regimens, including separate guidelines for orthopedic surgery.…”

Section: Opioid Prescribing Should Be Based On Expectedmentioning

confidence: 99%

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Consensus Statement for the Prescription of Pain Medication at Discharge after Elective Adult Surgery

Clarke

Manoo

Pearsall

et al. 2020

Canadian Journal of Pain

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This Consensus Statement provides recommendations on the prescription of pain medication at discharge from hospital for opioid-naïve adult patients who undergo elective surgery. It encourages health care providers (surgeons, anesthesiologists, nurses/nurse practitioners, pain teams, pharmacists, allied health professionals, and trainees) to (1) use nonopioid therapies and reduce the prescription of opioids so that fewer opioid pills are available for diversion and (2) educate patients and their families/caregivers about pain management options after surgery to optimize quality of care for postoperative pain. These recommendations apply to opioid-naïve adult patients who undergo elective surgery. This consensus statement is intended for use by health care providers involved in the management and care of surgical patients. A modified Delphi process was used to reach consensus on the recommendations. First, the authors conducted a scoping review of the literature to determine current best practices and existing guidelines. From the available literature and expertise of the authors, a draft list of recommendations was created. Second, the authors asked key stakeholders to review and provide feedback on several drafts of the document and attend an in-person consensus meeting. The modified Delphi stakeholder group included surgeons, anesthesiologists, residents, fellows, nurses, pharmacists, and patients. After multiple iterations, the document was deemed complete. The recommendations are not graded because they are mostly based on consensus rather than evidence. RÉSUMÉ Cette déclaration de consensus fait des recommandations pour la prescription d'analgésiques à la sortie de l'hôpital pour les patients adultes n'ayant jamais pris d'opiacés et qui subissent une intervention chirurgicale non urgente. Elle encourage les prestataires de soins de santé (chirurgiens, anesthésiologistes, infirmières et infirmiers, infirmières et infirmiers praticiens, équipes antidouleur, pharmaciens, professionnels de la santé et stagiaires) à (1) utiliser des traitements non opiacés et à réduire la prescription d'opiacés afin de réduire le nombre de pilules opiacées pouvant être détournées; et (2) à éduquer les patients, ainsi que leurs familles et soignants, sur les options de prise en charge de la douleur après l'opération afin d'optimiser la qualité des soins pour la douleur postopératoire. Ces recommandations s'appliquent aux patients adultes n'ayant jamais pris d'opioïdes et qui subissent une intervention chirurgicale non urgente. Cette déclaration de consensus est destinée à être utilisée par les prestataires de soins de santé impliqués dans la prise en charge des patients opérés et les soins qui leur sont apportés. Un processus Delphi modifié a été utilisé pour parvenir à un consensus sur les recommandations. Tout d'abord, les auteurs ont procédé à une de la portée de la littérature afin de déterminer les pratiques exemplaires actuelles et les lignes directrices existantes. À partir de la littérature disponible et de l'expertise des ...

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Individualized Compared With Standard Postdischarge Oxycodone Prescribing After Cesarean Birth

Abstract: ClinicalTrials.gov, NCT03168425.

Cited by 44 publications

References 12 publications

Opioid prescribing after childbirth: overprescribing and chronic use

Opioid prescribing after childbirth: overprescribing and chronic use

Substance use disorders in pregnancy: clinical, ethical, and research imperatives of the opioid epidemic: a report of a joint workshop of the Society for Maternal-Fetal Medicine, American College of Obstetricians and Gynecologists, and American Society of Addiction Medicine

Consensus Statement for the Prescription of Pain Medication at Discharge after Elective Adult Surgery

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