Abstract
INTRODUCTION: Women who use peripartum opioids for cesarean delivery have a 2.2% rate of new persistent opioid use. Opioids have consequences for breastfeeding women, and may contribute to CNS depression in the mother and her breastfed infant. Suboptimal perioperative pain management is associated with chronic pain, delayed functional recovery, impaired maternal-fetal bonding greater opioid use and postpartum depression. Women undergoing cesarean delivery may benefit from local anesthetics delivered by wound infiltration or transversus abdominis plane block. The ropivacaine continuous wound infusion device used in non-obstetrical surgery has shown clinically meaningful reductions in opioid use yet still good pain control. We hypothesize that mothers who use a continuous wound infiltration device for postpartum pain management use less narcotic pain medication compared to mothers who do not use the device. METHODS: This is a retrospective case-control study of 18 patients who received a wound infiltration device matched to 18 controls. Charts were abstracted for patient characteristics, length of stay (LOS) and morphine milligram milliequivalents (MME) of opioids used postpartum. RESULTS: The primary outcome of total MME and other demographic and clinical variables were not statistically associated with the use of the infiltration device (P>.05). The Spearman correlation coefficient between total MME and LOS (in days) was 0.38, which was not statistically different from zero (no association) with the p-value of 0.12. CONCLUSION: While non opioid adjuncts may be useful in reducing narcotic use postpartum, the wound infusion device did not appear to be more beneficial.
Published Version
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