<scp>Opioid‐free</scp> multimodal analgesia pathway to decrease opioid utilization after cesarean delivery

Mehraban, Shadan S.; Suddle, Rahat; Mehraban, Shadi; Petrucci, Samantha; Moretti, Michael; Cabbad, Michael; Lakhi, Nisha

doi:10.1111/jog.14582

Cited by 8 publications

(9 citation statements)

References 25 publications

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“…Sixteen studies identified interventions to reduce postpartum opioid use during the inpatient period. The majority included implementation of multimodal stepwise protocols (n = 8) [16][17][18][19][20][21][22][23] or changes in dosages or timing of medication administration (n = 4). [24][25][26][27] Four additional studies included interventions that compared nonopioid medication with placebo, 28 use of lidocaine patches, 29 abdominal binder, 30 and battlefield acupuncture, in which needles are placed only on the surface of the ear (Table 1 ).…”

Section: Interventions To Reduce Postpartum Opioid Use During the Inp...mentioning

confidence: 99%

Interventions to Reduce Inpatient and Discharge Opioid Prescribing for Postpartum Patients: A Systematic Review

Badreldin

DiTosto

Holder

et al. 2023

J Midwife Womens Health

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Introduction As deaths related to opioids continue to rise, reducing opioid use for postpartum pain management is an important priority. Thus, we conducted a systematic review of postpartum interventions aimed at reducing opioid use following birth. Methods From database inception through September 1, 2021, we conducted a systematic search in Embase, MEDLINE, Cochrane Library, and Scopus including the following Medical Subject Heading (MeSH) terms: postpartum, pain management, opioid prescribing. Studies published in English, restricted to the United States, and evaluating interventions initiated following birth with outcomes including an assessment of change in opioid prescribing or use during the postpartum period (<8 weeks postpartum) were included. Authors independently screened abstracts and full articles for inclusion, extracted data, and assessed study quality using the Grading of Recommendations, Assessment, Development, and Evaluation tool and risk of bias using the Institutes of Health Quality Assessment Tools. Results A total of 24 studies met inclusion criteria. Sixteen studies evaluated interventions aimed at reducing postpartum opioid use during the inpatient hospitalization, and 10 studies evaluated interventions aimed at reducing opioid prescribing at postpartum discharge. Inpatient interventions included changes to standard order sets and protocols for the management of pain after cesarean birth. Such interventions resulted in significant decreases in inpatient postpartum opioid use in all but one study. Additional inpatient interventions, including use of lidocaine patches, postoperative abdominal binder, valdecoxib, and acupuncture were not found to be effective in reducing postpartum opioid use during inpatient hospitalization. Interventions targeting the postpartum period included individualized prescribing and state legislative changes limiting the duration of opioid prescribing for acute pain both resulted in decreased opioid prescribing or opioid use. Discussion A variety of interventions aimed at reducing opioid use following birth have shown efficacy. Although it is not known if any single intervention is most effective, these data suggest that implementation of any number of interventions may be advantageous in reducing postpartum opioid use.

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Section: Interventions To Reduce Postpartum Opioid Use During the Inp...mentioning

confidence: 99%

Interventions to Reduce Inpatient and Discharge Opioid Prescribing for Postpartum Patients: A Systematic Review

Badreldin

DiTosto

Holder

et al. 2023

J Midwife Womens Health

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“…Similarly, a recent study by Mehraban et al evaluated a regimen consisting of as‐needed acetaminophen and NSAIDs with oxycodone reserved for breakthrough pain. They showed a reduction in inpatient and outpatient opioid consumption; however, pain scores were not compared before and after the intervention 16 …”

Section: Introductionmentioning

confidence: 99%

“…They showed a reduction in inpatient and outpatient opioid consumption; however, pain scores were not compared before and after the intervention. 16 Here we describe the implementation of a quality improvement (QI) initiative designed to promote adoption of evidence-based guidelines regarding postpartum pain management to reduce post-caesarean opioid use. The intervention consisted of four parts: (1) development of an order set in the electronic medical record (EMR) maximising the use of scheduled acetaminophen and NSAIDs, (2) education of nursing staff regarding the opioid reduction initiative and appropriate use of opioids only for breakthrough pain, (3) data-driven performance feedback to nursing staff and (4) physician education.…”

Section: Introductionmentioning

confidence: 99%

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

Llarena

Krivanek

Yao

et al. 2022

BJOG

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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.

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“…Postoperative pain following the ovariohysterectomy (OHE) of cats has been most commonly treated with opioidbased analgesia and nonsteroidal anti-inflammatory drugs (NSAIDs) [1,2]. However, concerns regarding opioid-induced hyperalgesia have motivated the investigation of nonopioid drugs to decrease postoperative pain in human and veterinary patients [3][4][5]. A variety of non-opioid analgesics such as lidocaine, ketamine, and dexmedetomidine have been utilized in multimodal analgesic approaches to improve the effects of perioperative analgesia and minimize small animals' opioid consumption [4,6,7].…”

Section: Introductionmentioning

confidence: 99%

Effects of Lidocaine Injection at Acupuncture Points on Perioperative Analgesia in Cats Undergoing Ovariohysterectomy

Lima

Segatto

Zanelli

et al. 2022

J Acupunct Meridian Stud

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Background: Pharmacopuncture is an acupuncture-related technique that has been used to amplify the therapeutic effects of different medications. Objectives: To investigate the analgesic efficacy of a lidocaine injection at acupoints in cats undergoing ovariohysterectomy. Methods: Thirty cats were randomly distributed into two groups (n = 15, per group). The experimental group received a bilateral administration of lidocaine at the following acupoints: Stomach 36 (ST-36) and Spleen 6 (SP-6) (Lido group). The control group did not receive lidocaine (Control group). All cats were sedated with dexmedetomidine and anesthesia was induced with propofol and maintained with isoflurane. Intraoperatively, fentanyl was given to control cardiovascular responses to surgical stimulation. Postoperative pain was assessed at various time points, up to 24 hours after extubation, using the UNESP-Botucatu multidimensional composite pain scale (MCPS) and Glasgow feline composite measure pain scale (CMPS-Feline). Sedation scores were measured at the same time points. Morphine/meloxicam was administered as rescue analgesia. Data were analyzed using t-tests, Fisher´s exact test, the Mann-Whitney test, and the Friedman test (p < 0.05). Results: Intraoperatively, more cats in the Control group required analgesic supplementation than those in the Lido group, but the difference was not significant (p = 0.65). Postoperative pain, sedation scores, and analgesic requirements did not differ between groups. Rescue analgesia was given to 67% (10/15) of the cats in each group. Conclusion:The administration of lidocaine at ST-36 and SP-6 acupuncture points did not provide significant perioperative analgesic benefits in healthy cats undergoing ovariohysterectomy.

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Opioid‐free multimodal analgesia pathway to decrease opioid utilization after cesarean delivery

Cited by 8 publications

References 25 publications

Interventions to Reduce Inpatient and Discharge Opioid Prescribing for Postpartum Patients: A Systematic Review

Interventions to Reduce Inpatient and Discharge Opioid Prescribing for Postpartum Patients: A Systematic Review

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

Effects of Lidocaine Injection at Acupuncture Points on Perioperative Analgesia in Cats Undergoing Ovariohysterectomy

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