Cost comparison of intrathecal morphine to intravenous patient-controlled analgesia for the first 24h post cesarean delivery: a retrospective cohort study.

Abstract

Intrathecal morphine provides superior pain control for patients undergoing cesarean delivery when compared to intravenous opioid patient-controlled analgesia. However, no study has assessed the overall cost associated with each modality as a primary outcome. The aim of this study is to determine the overall cost of each modality for the first 24h post cesarean delivery. Charts of patients undergoing cesarean delivery at our institution from January 1, 2014 to December 31, 2014 were reviewed. Patients receiving intrathecal morphine were compared to patients undergoing general anesthesia and receiving intravenous opioid patient-controlled analgesia for post-procedure analgesia. The primary outcome measured was total cost of each modality for the first 24h after delivery. Secondary outcomes included post-procedure pain scores, time to removal of the Foley catheter, need for rescue medications, and adverse events. There was a significant difference in total cost of intrathecal morphine when compared to intravenous opioid patient-controlled analgesia ($51.14 vs. $80.16, p<0.001). Average pain scores between 0-1h (0 vs. 5, p<0.001) and 1-6h (2.5 vs. 3.25, p<0.001) were less in the intrathecal morphine group. The intrathecal morphine group received more ketorolac (p<0.001) and required more rescue opioids (p=0.042). There were no significant differences in documented adverse events. The use of intrathecal morphine for post-cesarean pain control leads to a significant cost savings for the first 24h when compared to intravenous opioid patient-controlled analgesia. Patients also experienced less pain and were not at increased risk for adverse events.