Self-Reported Non-Steroidal Anti-Inflammatory Drug Allergy and Postpartum Pain Management [36M

Abstract

INTRODUCTION: Patients with a self-reported NSAID allergy (SRNA) are limited in the medications available to treat postpartum pain. Our objective was to determine the frequency of SRNA, how it affects the medications administered for inpatient postpartum analgesia, and whether it is associated with obstetrical outcomes. METHODS: Retrospective cohort study of singleton deliveries at ≥37 weeks of gestation at a tertiary university hospital from 2013-2016. Patients were excluded for self-reported opioid allergies, drug abuse history, positive urine toxicology, general anesthesia for delivery, and incomplete records. The primary outcomes evaluated were the postpartum pain medications received, including the total amount in milligrams. Demographic and clinical characteristics were reviewed to identify any associations with SRNA. RESULTS: A total of 20,920 deliveries were included: 235 with SRNA and 20,685 without SRNA. SRNA was documented in 1.12% of the study population. After cesarean delivery, median oxycodone use was 19.4 (IQR 6.6-36.7) and 15.4 (IQR 2.6-28.6) mg/day among women with and without SRNA, respectively (P<.04). After vaginal delivery, median oxycodone use was 10.4 (IQR 0-32.9) and 0 (IQR 0-17.9) mg/day among women with and without SRNA, respectively (P<.001). Acetaminophen use (P<.0001) and total postpartum days (P<.05) were also increased in women with SRNA compared to women without SRNA. No demographic or clinical factors differed between groups. CONCLUSION: SRNA is documented in approximately 1% of obstetrical patients and affects the medications administered for inpatient postpartum analgesia; both oxycodone and acetaminophen use are increased among SRNA patients, regardless of mode of delivery.