Postpartum Opioid Use Following Vaginal Deliveries with No or Minor Obstetric Perineal Lacerations

Abstract

Background: Recommendations for management of pain following vaginal delivery are not specific and do not differentiate patients based on the degree of perineal trauma. Our objective is to describe patterns of postpartum opioid use in women with no or minor perineal trauma. Methods: This is a retrospective cohort study describing the characteristics of opioid analgesia usage among women with no or minor perineal lacerations at the time of vaginal delivery in a university affiliated regional hospital. Results: For the 6-month study period, 433 patients were eligible for inclusion. Of these, 423 (97.69%) were ordered as needed narcotics during their post-partum hospitalization. Of women with an as needed narcotic prescribed, 285 (65.82%) used at least one dose of narcotics while hospitalized. Significant patient characteristics of women using opioids during their inpatient post-partum course included those who used epidural analgesia during labor (p=0.009) and primiparous patients (p=0.05). Thirty-five of the women included in the study received a prescription for opioid analgesics at the time of discharge (8.08%). Significant findings among these women include increasing maternal age (p=0.007). Non-academic physicians with resident coverage were 3.1 times more likely to prescribe opioids at discharge compared to academic physicians with residents and non-academic physicians without resident coverage. Conclusions: Focusing specifically on women with no or minor perineal lacerations at the time of delivery, our findings indicate that if given the option of opioids analgesia during their hospitalization, many women will request at least one dose of opioid analgesia, but rarely require opioids after discharge.