1152 Enhanced recovery after surgery pathway for cesarean delivery decreases postpartum opioid use

Abstract

To evaluate the effect of implementing an enhanced recovery after surgery (ERAS) pathway for all cesarean deliveries on postpartum opioid use and pain control We conducted a prospective quality improvement study comparing postoperative opioid use before and after implementation of an ERAS pathway for cesarean delivery (CD). The ERAS pathway included preoperative, intraoperative, and postoperative components, with emphasis on preoperative preparation, hemodynamic optimization, early mobilization and multimodal analgesia. All women undergoing CD, whether scheduled, urgent, or emergent, were included. Demographic, delivery, and inpatient opioid use data were obtained by chart review. Two weeks after discharge, women were surveyed about their delivery experience, analgesic usage, and complications. The primary outcome was inpatient opioid use. The study included 128 women, 56 in the pre-ERAS cohort and 72 in the ERAS cohort. Baseline characteristics, surgical indications, and procedural characteristics for the two groups were similar. The postpartum survey response rate was 94/128 (73%). Opioid use in the first 48 hours postoperatively was significantly lower in the ERAS group compared to the pre-ERAS group (9.4 vs. 21.4 morphine milligram equivalents (MME) 0-24 hours postpartum, p< 0.001; 14.1 vs. 25.4 MME 24-48 hours postpartum, p< 0.001) with no increase in either average or maximum postoperative pain scores. Women in the ERAS group were prescribed fewer opioid pills at discharge compared to the pre-ERAS group (17 vs. 23, p< 0.001) and took fewer opioid pills after discharge (8 vs. 19, p< 0.001). Patient satisfaction and complication rates did not change after ERAS implementation. Implementation of an ERAS pathway for all scheduled and unscheduled cesarean deliveries decreases both inpatient and outpatient postpartum opioid use without increasing pain scores or decreasing patient satisfaction.View Large Image Figure ViewerDownload Hi-res image Download (PPT)