Use-Based Opioid Prescribing Protocol Reduces Opioid Prescriptions After Cesarean Section [ID 2683514

Abstract

INTRODUCTION: Up to 75% of post-cesarean patients report having up to 50% of their discharge opioid prescription left over. We assessed an institutional standardized post-cesarean section pain management and opioid prescribing protocol implemented to decrease unused opioids entering the community while still adequately managing pain. METHODS: This was an IRB-approved single-center retrospective comparative cohort study in patients aged 18 years or older, who underwent cesarean section before or after implementation of standardized pain management and opioid prescribing protocol. The intervention group received scheduled acetaminophen and NSAIDs with oxycodone 5 to 10 mg as needed postoperatively. Opioid consumption during the 24 hours prior to discharge was used with set ranges determine the quantity of opioid to prescribe for discharge. Outcomes included opioid prescription receipt, quantity of opioid prescribed, and supplementary opioid prescription within 30 days of discharge. RESULTS: Four hundred thirty-three patients were included, with 255 in the intervention group and 208 in the control group. The intervention group used less oxycodone postoperatively (75.1%, 17.8%, and 7.1% of patients using 45 mg, respectively, versus 52.4%, 30.3%, and 17.3%; P<.001), received fewer opioid prescriptions (79.1% versus 89.4%; P=.041), and fewer oxycodone tablets if prescribed (median [interquartile range]: 15 [5–20] versus 30 [20–30]; P<.001). There was no significant difference in number of supplemental post-discharge opioid prescriptions received. CONCLUSION: A standardized post-cesarean section pain management and opioid prescribing protocol significantly reduced the number of both opioid prescriptions written and number of tablets prescribed without increasing patients seeking opioid refills in the 30 days following discharge.