1036: Changing the as-needed opioid medication order to reduce opioid consumption after cesarean delivery

Abstract

To evaluate the effect of reducing the amount of as-needed opioids ordered following cesarean delivery (CD) on inpatient opioid consumption and analgesia. As part of a larger opioid stewardship initiative at our tertiary care institution, our standard as-needed opioid order was reduced from oxycodone 5-10mg every 4 hours to oxycodone 5mg every 6 hours, effective May 1, 2019. Standing orders for non-opioid analgesics remained the same: acetaminophen 650mg every 6 hours and ibuprofen 600mg or ketorolac 30mg every 6 hours. We compared opioid use and pain scores before the order change (Nov 2018-Apr 2019) and after the order change (May 2019-Jul 2019). Our primary outcome was the proportion of patients using > 30mg of oxycodone in the 24 hours prior to discharge, which was selected due to the consensus guidelines that breastfeeding women avoid taking more than 30mg per day of oxycodone. We further assessed the proportion of patients with pain scores >4/10 (moderate) and >7/10 (severe), as well as mean postoperative pain scores during hospitalization and hospital length of stay. Opiate use and pain scores were available for 724 women who underwent CD during the study period. In the baseline period, 15.2% (66/434) used > 30mg of oxycodone in the 24 hours before discharge, compared with 5.2% (15/290) after the orderset change. There was no change in the proportion of women with one or more pain score > 7 (Pre: 46/1%, Post: 43/1%, p=0.43) or >4 (Pre:81.8%, Post: 82.8%, p=0.74), nor was there a change in mean pain score (mean, SD Pre: 2.8, 1.6; Post: 2.7, 1.6, p=0.29). Length of stay did not differ between the groups. Changing the availability of as-needed oxycodone from 5-10mg every 4 hours to 5mg every 6 hours results in a reduction in the number of women requiring >30mg oxycodone in the 24 hours prior to discharge without an increase in patient pain scores or hospital length of stay. A multimodal analgesic regimen of scheduled non-steroidal anti-inflammatory medications and acetaminophen is effective for analgesia with low opioid requirements.