Narcotic Use After Cesarean: Separate Versus Combined Regimens of Oxycodone and Acetaminophen [22E

Abstract

INTRODUCTION: In the management of post-cesarean analgesia narcotic medications remain a mainstay of treatment. It is well documented that NSAIDS and acetaminophen help reduce the amount of narcotic needed to control post-operative pain, however there is still no consensus on which multimodal regimen is superior. In our study we investigate the impact of different analgesic regimens on narcotic use during post-cesarean hospitalization. METHODS: This study is a part of a larger IRB approved study examining the impact of an Enhanced Recovery After Surgery (ERAS) protocol for cesarean deliveries. Data collected from 2/1/19–5/31/19 were part of the retrospective chart review of patients who underwent cesarean section. The study was powered to detect a 30% reduction in narcotic use between groups with of 86 per group. Statistical analysis was completed using SAS. RESULTS: The primary outcome was intravenous morphine mg equivalents (mEq) per 12-hour period while hospitalized. Analysis was performed on two dosing regimens: oxycodone (ordered separately from acetaminophen) (N=67), and combined oxycodone-acetaminophen (N=83). Ninety-five percent of patients additionally received NSAIDS in the form of ketorolac and/or ibuprofen. After controlling for potential confounders, patients in the oxycodone group received an average of 4.6 mEq/12 hours compared to the combination oxycodone-acetaminophen group who averaged 5.7 mEq/12 hours, P=.01. Over an average length of stay of 80.8 hours this equaled a difference of 7.41 mEq or 14.82 mg oxycodone, a 19.3% reduction. CONCLUSION: Our findings suggest that for patients undergoing cesarean section a regimen of oxycodone and acetaminophen ordered separately may lead to a clinically significant decrease in narcotic use during admission.