Patients' Experiences With an Opioid-Sparing Protocol Following Cesarean Delivery [28E

Abstract

INTRODUCTION: Overprescribing of opioids after cesarean delivery may lead to overconsumption and opioid diversion. Opioid-sparing protocols have reduced post-cesarean inpatient opioid use by over half, but how they affect post-discharge opioid use has not been explored. This study describes the impact of a post-discharge opioid-sparing protocol on home opioid use for women undergoing cesarean delivery. METHODS: At our academic institution, all patients undergoing cesarean delivery receive an opioid-sparing protocol, including scheduled (not as needed) acetaminophen and ibuprofen at discharge. Patients are prescribed ≤20 tabs of oxycodone for breakthrough pain. We conducted a telephone survey of post-cesarean women, 4–12 weeks after discharge on utilization of opioid and non-opioid pain medication and pain control. Data were analyzed using descriptive statistics. RESULTS: Of the 394 women contacted, 205 agreed to participate (52%). Most patients were multiparous (average parity=2) and had an unplanned cesarean delivery (67%). Most patients utilized ≥1 opioid alternative (75% Tylenol and ibuprofen, 14% Tylenol only, 9% ibuprofen only). Overall, 80% of patients received an opioid prescription, and 62% consumed opioids. Patients received on average 17 pills (range 0–20) and consumed 9 pills (range 0–20). Only 7% of patients received a refill. Of the 121/205 (63%) patients who reported good pain control with opioid alternatives, 56/205 (27%) still reported using opioids. CONCLUSION: Most patients report good pain control after cesarean with non-opioid medication and use fewer opioids than prescribed. Still, education is needed to help patients match pain needs to appropriate medication and limit unnecessary opioid exposure.