Association Between Obesity and Opioid Usage for Pain Management in Postpartum Women [05D

Abstract

INTRODUCTION: The objective was to assess the relationship between obesity and opioid usage for women postpartum. METHODS: This study was a secondary data analysis of an RCT (NCT02909582), limited to women with a BMI ≥35 kg/m2 at delivery. A standard order set for postpartum pain medications was utilized inpatient. Opioids consumed postpartum were converted to milligrams of oral morphine equivalents. Outcomes included milligrams of morphine equivalent used in the first 48 hours of delivery and the highest pain score within the first 48 hours post-delivery. Relationships were explored with correlation and linear regression (accounting for demographic factors). RESULTS: BMI at delivery does not correlate with the mg of morphine equivalents utilized (n=273 women, Pearson r 0.034, P=.579) or the highest pain score (r 0.028, p 0.643) in the first 48 hours postpartum. Pain scores and opioid consumption were correlated (r=0.445, P<.001). Age (RR 6.13; 95% CI 0.65, 11.61; P=.029) and race (RR -12.8; 95% CI -20.93, -4.66; P=.002) were significantly associated with opioids consumed when accounting for demographics, including mental health diagnosis. Both black and white patients had similar mean highest pain scores in the first 48 hours postpartum (6.5 vs 6.3). However, black patients used almost 1/3 less milligrams of opioids (mean 29.4 mg vs 41.1). CONCLUSION: The relationship between obesity and pain postpartum is complex, and includes mediating factors such as ethnicity, age, and presence of a mental health disorder. Despite a standardized pain medication order set and similar pain scores, there are racial differences in utilization of pain medications postpartum.