Perspectives of Postpartum Pain Management Among Patients With Prenatal Opioid Exposure [A252

Abstract

INTRODUCTION: Opioid-sparing protocols can reduce postpartum opioid prescribing in opioid-naïve patients; however, patients with a history of opioid use disorder (OUD) and chronic pain are typically excluded from evaluations. We assessed the postpartum pain experience in patients who were not opioid-naïve before delivery. METHODS: We conducted a phone survey assessing maternal postpartum pain experiences for all patients with OUD and chronic pain on opioids prenatally who delivered between January 2020 and August 2021 at a single hospital. In this IRB exempt study, verbal informed consent was obtained for all participants. Analyses included simple descriptive statistics. RESULTS: Of 24 patients successfully contacted, 17 (71%) participated. Patients were predominantly White (100%, 17/17), publicly insured (76%, 13/17), multiparous (82%, 14/17), had a vaginal delivery (53%, 9/17), and had an average age of 32. Patients were most commonly identified as having OUD (88%, 15/17) followed by chronic pain (12%, 2/17). About a quarter (4/17, 24%) reported poor pain control (7/10 or greater) in the hospital and one week after discharge. Among patients with vaginal deliveries, 11% (1/9) used opioids postpartum, 78% (7/9) used acetaminophen, and 67% (6/9) used ibuprofen. Among cesarean births, 50% (4/8) used opioids postpartum, 100% (8/8) used acetaminophen, and 75% (6/8) used ibuprofen. Of the 69% (11/16) who reported breastfeeding, 45% (5/11) reported some pain interference. CONCLUSION: Many patients on maintenance opioids prenatally reported poor postpartum pain control. Non-opioid medications were not optimized in patients undergoing cesarean delivery, suggesting an opportunity for better opioid-sparing pain management strategies.