170 The impact of pre-existing maternal anxiety on pain and opioid use following cesarean birth

Abstract

To assess the impact of maternal anxiety on post-operative pain and opioid use (morphine mg equivalent (MME)) use following cesarean birth. This was a retrospective cohort study of opioid-naive women who underwent cesarean delivery at Meriter Hospital in Madison, WI between 01/01/2016 and 12/31/2017. After excluding incomplete records and women with opioid use disorder, there were a total of 2228 records reviewed. Pain was assessed by averaging all recorded pain scores (assessed on a 0-10 scale) in the first 24 hours post-delivery, which were manually abstracted. Linear regression was used to analyze the impact of anxiety on average pain and MME use. Women with documented anxiety had significantly higher average pain scores than women without anxiety (3.9 vs 3.5, p<0.001), including in multivariate analysis (coefficient: 0.281, 95% CI [0.135-0.427], p<0.001) (Table 1). Women with anxiety also had higher MME use than women without anxiety (110.4 mg vs 102.2 mg, p<0.001), an association that remained significant in multivariate analysis (coefficient: 4.28 mg, 95% CI [0.70-7.85], p=0.019) (Table 2). Pre-existing depression was also noted to be associated with higher average pain (coefficient: 0.248, [0.100-0.396], p=0.001) (Table 1) and MME use (coefficient: 4.97 mg [1.33-8.60], p=0.007) (Table 2). Pre-existing maternal anxiety and depression were associated with higher average pain scores and opioid pain medication use in the first 24 hours following Cesarean delivery. Our results on the association of pain and opioid use with depression is consistent with prior studies. The relationship of pre-existing anxiety to pain and opioid use has not been previously demonstrated in this population. Knowledge of pre-existing anxiety in women undergoing Cesarean birth may be useful for anticipating post-operative pain control challenges for these patients.View Large Image Figure ViewerDownload Hi-res image Download (PPT)