787: The effect of neuraxial morphine (Duramorph) on postpartum pain after a severe perineal laceration

Abstract

Postpartum pain has negative consequences on maternal-infant bonding, future narcotic abuse, and development of chronic pain. With the rise of the opioid epidemic, it is important to find novel approaches in managing this pain. This pilot study investigates the use of neuraxial morphine (Duramorph) in postpartum pain control after a severe perineal laceration. A single-blind randomized controlled trial (NCT03926559) was conducted on parturients admitted to the obstetric service at Augusta University Medical Center. Patients were enrolled if they had an epidural and if they had a second, third, or fourth degree perineal laceration that was identified immediately postpartum. Participants were randomized to receive either 2mg of Duramorph or sham injection of no drug within 30 minutes after their perineal laceration repair, prior to the removal of their epidural. Primary outcomes were perineal pain at 24 and 48 hours postpartum as measured on a 11-point Numerical Rating Scale (NRS-11). Secondary outcomes were amount of additional oral narcotics used in morphine milliequivalents (MME) over 24 and 48 hours postpartum, and maternal satisfaction as measured on a Likert (1-10) scale. Between 04/2019 to 08/2019, 154 patients were consented, of which 78 patients had a severe perineal tear and were eligible for the study. 58, 13, and 7 patients had second, third, and fourth degree perineal tears respectively. Baseline demographic characteristics between the groups were comparable. As seen in Table 1, there was a statistically significant reduction in pain scores at 24 hours in women who received Duramorph compared to sham for all perineal tears. There was also a statistically significant decrease in narcotic use at 24 hours, as well as an increase in maternal satisfaction for all perineal tear groups in the Duramorph group compared to sham (Table 2). The use of Duramorph in the immediate postpartum setting may alleviate pain in the first 24 hours and may also decrease the number of oral narcotics consumed during the early postpartum period.View Large Image Figure ViewerDownload Hi-res image Download (PPT)