Postpartum Pain Management Research Articles

45 - Postpartum pain management using the non-pharmacological, conservative therapies: results of a scoping review.

45 - Postpartum pain management using the non-pharmacological, conservative therapies: results of a scoping review.

Study on Impact of Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) on Renal Function in Postpartum Period

A prospective, observational study was conducted in the Department of Obstetrics & Gynaecology of Combined Military Hospital (CMH), Dhaka, Bangladesh, to assess pre-delivery and post-delivery (5 days after administration of NSAID) change in renal function by determining the serum creatinine levels in pregnant women. The study was conducted on 120 purposively selected patients attending for their delivery purpose in the selected hospital from January to June of 2022. Following the delivery, tablet Paracetamol 500 mg thrice a day for 5 days have been prescribed to all the respondents. Diclofenac Sodium 100 mg suppository twice a day up to for 3 days had been prescribed with dosage adjusted as required. Serum creatinine levels were evaluated on two time points: the day before delivery and 5 days after delivery. Compared to the day before delivery, 53.3% of the respondents showed increased level of serum creatinine 5 days after delivery. Acute kidney injury (AKI) was identified in 9.17% patients with a change more than 0.3 mg/dL from the pre-delivery report. The change in the serum creatinine level pre-delivery to post delivery was statistically significant, which was also dependent on the NSAIDs dose with a positive linear association. Though NSAIDs regarded as a safe choice for postpartum pain management, yet apparently healthy mothers showed fluctuations in serum creatinine level in association to dosage of NSAIDs use. CBMJ 2024 July: vol. 13 no. 02 P: 141-147

The comparison of effectiveness of acupressure on Spleen 6 and Hugo points on the severity of postpartum pain: A randomized clinical trial.

Postpartum pain poses a significant challenge for new mothers. Various nonpharmacological methods are employed to manage postpartum pain. This study aimed to compare the effectiveness of acupressure on Spleen 6 and Hugo points on the severity of postpartum pain. In this parallel randomized trial study, 68 eligible primiparous women who had vaginal deliveries and experienced postpartum pain at Farabi Hospital in Malekan (a city in East Azarbaijan Province in Iran) were selected according to inclusion/exclusion criteria and then allocated to the Hugo (n = 34) and Spleen 6 (n = 34) acupressure groups using a randomized block design (six blocks). The data collection process took place from November 2022 to April 2023. The participants were blinded; however, the analysts and investigators were not blinded. Acupressure interventions were applied bilaterally for 20 min, consisting of 10 s of pressure followed by 2 s of rest. Pain intensity was assessed using a visual pain scale before, immediately after, and 1 h after the intervention. In total, 68 participants fulfilled the study. Data were analyzed using Statistical Package for the Social Sciences version 25 with chi-square, Mann-Whitney, and Friedman tests. Both groups exhibited a statistically significant reduction in postpartum pain intensity across all periods (p < 0.001). Although there was a significant difference in pain intensity between the groups before the intervention (p = 0.039), this distinction was not observed immediately and 1 h after the intervention (p ≥ 0.05). Both Hugo and Spleen's 6 acupressure interventions reduced postpartum pain intensity. No significant adverse events or side effects were observed. Acupressure on Spleen 6 and Hugo points helped decrease the severity of postpartum pain in primiparous women who had vaginal deliveries. Healthcare providers are encouraged to consider acupressure for postpartum pain management.

Multiple marginalized identities: A qualitative exploration of intersectional perinatal experiences of birthing people of color with substance use disorder in Massachusetts

IntroductionRacial and ethnic inequities persist in receipt of prenatal care, mental health services, and addiction treatment for pregnant and postpartum individuals with substance use disorder (SUD). Further qualitative work is needed to understand the intersectionality of racial and ethnic discrimination, stigma related to substance use, and gender bias on perinatal SUD care from the perspectives of affected individuals. MethodsPeer interviewers conducted semi-structured qualitative interviews with recently pregnant people of color with SUD in Massachusetts to explore the impact of internalized, interpersonal, and structural racism on prenatal, birthing, and postpartum experiences. The study used a thematic analysis to generate the codebook and double coded transcripts, with an overall kappa coefficient of 0.89. Preliminary themes were triangulated with five participants to inform final theme development. ResultsThe study includes 23 participants of diverse racial/ethnic backgrounds: 39% mixed race/ethnicity (including 9% with Native American ancestry), 30% Hispanic or Latinx, 26% Black/African American, 4% Asian. While participants frequently names racial and ethnic discrimination, both interpersonal and structural, as barriers to care, some participants attributed poor experiences to other marginalized identities and experiences, such as having a SUD. Three unique themes emerged from the participants' experiences: 1) Participants of color faced increased scrutiny and mistrust from clinicians and treatment programs; 2) Greater self-advocacy was required from individuals of color to counteract stereotypes and stigma; 3) Experiences related to SUD history and pregnancy status intersected with racism and gender bias to create distinct forms of discrimination. ConclusionPregnant and postpartum people of color affected by perinatal SUD faced pervasive mistrust and unequal standards of care from mostly white healthcare staff and treatment spaces, which negatively impacted their treatment access, addiction medication receipt, postpartum pain management, and ability to retain custody of their children. Key clinical interventions and policy changes identified by participants for antiracist action include personalizing anesthetic plans for adequate peripartum pain control, minimizing reproductive injustices in contraceptive counseling, and addressing misuse of toxicology testing to mitigate inequitable Child Protective Services (CPS) involvement and custody loss.

Disparities in Postpartum Pain Management After Cesarean Delivery [ID 2683520

INTRODUCTION: We evaluated whether postpartum pain management differs by practice setting, ethnicity, insurance, and preferred language in women with cesarean deliveries (CDs). METHODS: This is a retrospective cohort study. Participants who underwent CD at term between 2021 and 2022 were included. Participants with history of opioid use, allergies to NSAIDS, general anesthesia, and postpartum stay greater than 5 days were excluded. The outcomes measures include number of oral “as needed” opioids received measured in morphine milligram equivalents, frequency of pain scores done on the postpartum unit, initial pain scores, pain scores at discharge, and the type and amount of opioids prescribed at discharge. The association of these outcomes based on practice setting (federally funded health center [FFHC] versus private practice [PP]), public versus private insurance, preferred language (English versus non-English), and Hispanic versus Non-Hispanic ethnicity were evaluated. Institutional review board approval was obtained. RESULTS: Four hundred seventy-nine participants were included. FFHCs received less “as-needed” opioids than patients of PP (P=.03). Publicly insured received less opioids than privately insured at discharge (P=.03). English-speaking participants were asked about their pain more frequently (P=.05) and received more inpatient opioids than non-English-speaking participants (P=.00). Non-Hispanic participants were asked about their pain more frequently (P=.042) and were more likely to be discharged with opioid-only medications (P=.04) than Hispanic patients who were discharged with combined medications (P=.03). CONCLUSION: Women attending FFHC, non-English-speaking, with public insurance, and of Hispanic ethnicity experience disparities in postpartum pain management. Targeted protocols should be developed to eliminate the disparities that exist in postpartum pain management.

Patient and Provider Perspectives on Postpartum Pain Management in Individuals With Opioid Use Disorder and Chronic Pain [ID 2683542

INTRODUCTION: Birthing people with opioid use disorder (OUD) and chronic pain (CP) face significant barriers to effective postpartum pain management including medical complexity of analgesic decisions as well as stigma and bias towards individuals with these diagnoses. To date, clinical practice guidelines (CPGs) for patients with OUD and CP have lacked patients’ perspectives. We sought to capture voices of patients and their medical providers to inform effective, equitable pain management CPGs for birthing people with OUD and CP. METHODS: We performed a subgroup analysis of 31 patient and 22 provider interviews conducted to develop CPGs. Institional review board approval was obtained along with participant consent, and data were de-identified. We isolated quotes pertaining to OUD and CP from participants with and providers caring for individuals with these conditions. We then used inductive thematic analysis, allowing insights to emerge from the data. RESULTS: In total, 266 quotes were identified relating to OUD and CP. Five key themes emerged from the data: 1) the need to mitigate health care team bias to improve pain management access and experience; 2) the need for standardized sets of pain management options for all patients; 3) the importance of tailoring pain management plans to individuals’ unique needs; 4) the need to partner with patients in creating pain management plans to promote trust and autonomy; and 5) the importance of interprofessional teams in treating postpartum pain for individuals with OUD and CP. CONCLUSION: Interviews with patients and the people who care for them reveal important considerations for CPGs that improve rather than exacerbate existing disparities for birthing people with OUD and CP. Implementation of CPGs informed by patients’ lived experiences is a crucial step in ensuring equitable options for postpartum pain management in patients who face significant biases and barriers to effective care.

Application Of Pbm-Nir Therapy For Postpartum Mother's Discomfort In Maternity Nursing Care

Normal post partum is post partum discomfort due to uterine involution. Uterine involution in patients can cause pain in the uterus called afterpains. Discomfort caused by uterine involution requires various treatments to minimize the pain felt by the mother so that the mother's comfort can return. This can be overcome with non-pharmacological pain management strategies through innovative near infrared phototherapy or near infrared photobiomodulation (PBM NIR). The aim of this research is to analyze the results of implementing pain management with non-pharmacological PBM NIR therapy in normal post-partum mothers with post-partum discomfort nursing problems. Case study that focuses on the implementation of non-pharmacological nursing pain management techniques with PBM NIR therapy. The case study subjects were 3 normal post-partum maternal patients with the same problem, namely post-partum discomfort in the obstetrics room at the Muhammadiyah Hospital in Palembang. The results of the study showed that the implementation of non-pharmacological pain management techniques with PBM NIR therapy had an effective effect on dealing with post-partum discomfort with complaints of decreased discomfort, decreased moaning, and strong uterine contractions. Implementation of pain management can improve the comfort status of normal postpartum mothers. This study makes an important contribution to understanding of the role of nonpharmacological techniques in postpartum pain management, as well as highlighting the importance of implementing innovative therapies for labor, as well as highlighting the importance of implementing innovative therapies to improve the quality of care in postpartum mothers.

Fixed-time interval vs on-demand oral analgesia after vaginal delivery: a randomized controlled trial

Scheduled administration of analgesics was proven superior to on-demand dosing following cesarean deliveries. However, this protocol was not compared after vaginal delivery. To compare the efficacy of a fixed- vs on-demand analgesic protocol for the management of pain in the first 24 hours after a vaginal delivery. This randomized, prospective, controlled trial was conducted at a single tertiary medical center between June 1, 2020 and June 30, 2022. Vaginally delivered patients were randomly assigned to receive oral analgesics (paracetamol 1 g + ibuprofen 400 mg) either every 6 hours for the first 24 hours postpartum (scheduled analgesia group) or as needed (on-demand group). Pain level during the first 24 hours postdelivery was measured using a 10-point visual analog scale. A total of 200 patients were randomized 1:1 to the 2 cohorts. Baseline and delivery characteristics, including oxytocin augmentation, epidural anesthesia, episiotomy rate, and neonatal birthweight, were comparable between groups. Patients in the scheduled group received more paracetamol and ibuprofen doses in the first 24 hours (2.9±1.3 and 2.9±1.2 doses vs 0.8±1.1 and 0.7±1.1 doses, respectively; P<.001). Pain score was comparable between study groups (5.31±1.92 vs 5.29±1.67; P=.626) even after subanalysis for primiparity, episiotomy, and vacuum-assisted delivery (P>.05). However, patients on a fixed treatment schedule were more likely to breastfeed their baby (98% vs 88%; P=.006) as than those receiving treatment on demand. In addition, they were more satisfied with their labor and delivery experience, as evaluated by Birth Satisfaction Scale questionnaires quality control (37.9±4.7 vs 31.1±5.2; P=.0324), patient attributes (35.0±5.1 vs 30.3±6.3; P=.0453), and stress experienced (58.1±8.5 vs 50.1±8.3; P=.0398). No side effects or adverse outcomes were reported in either group. A scheduled analgesic protocol for postpartum pain management following vaginal delivery revealed similar pain scores compared with an on-demand protocol, although it was associated with higher breastfeeding rates and higher maternal satisfaction.

Racial/Ethnic Disparities in Peripartum Pain Assessment and Management

This study was conducted to determine if there were racial/ethnic disparities in pain assessment and management from labor throughout the postpartum period. This was a retrospective cohort study of all births from January 2019 to December 2021 in a single urban, quaternary care hospital, excluding patients with hysterectomy, ICU stay, transfusion of more than 3 units of packed red blood cells, general anesthesia, or evidence of a substance abuse disorder. We characterized and compared patterns of antepartum and postpartum pain assessments, epidural use, pain scores, and postpartum pain management by racial/ethnic group with bivariable analyses. Multivariable regression was performed to test for an association between race/ethnicity and amount of opioid pain medication in milligram equivalent units, stratified by delivery mode. There were 18,085 births between 2019 and 2021 with available race/ethnicity data. Of these, 58.3% were white, 15.0% were Hispanic, 11.9% were Asian, 7.4% were Black, and the remaining 7.4% were classified as Other/Declined. There were no significant differences by race/ethnicity in the number of antepartum or postpartum pain assessments or the proportion of patients who received epidural analgesia. Black and Hispanic patients reported the highest maximum postpartum pain scores after vaginal and cesarean birth compared to white and Asian patients. However, Black and Hispanic patients received lower daily doses of opioid medications than white patients, regardless of delivery mode. After adjusting for patient factors and non-opioid medication dosages, all other racial/ethnic groups received less opioid medication than white patients. Inequities were found in postpartum pain treatment, including among patients reporting the highest pain levels.

526 Bedside nurses' perspectives on the role of language barriers on postpartum pain management

526 Bedside nurses' perspectives on the role of language barriers on postpartum pain management

Nonsteroidal anti-inflammatory drug “allergy” labeling is associated with increased postpartum opioid utilization

Current guidelines recommend a stepwise approach to postpartum pain management, beginning with acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs), with opioids added only if needed. Report of a prior NSAID-induced adverse drug reaction (ADR) may preclude use of first-line analgesics, despite evidence that many patients with this allergy label may safely tolerate NSAIDs. We assessed the association between reported NSAID ADRs and postpartum opioid utilization. We performed a retrospective cohort study of birthing people who delivered within an integrated health system (January 1, 2017, to December 31, 2020). Study outcomes were postpartum inpatient opioid administrations and opioid prescriptions at discharge. Statistical analysis was performed on a propensity score-matched sample, which was generated with the goal of matching to the covariate distributions from individuals with NSAID ADRs. Of 38,927 eligible participants, there were 883 (2.3%) with an NSAID ADR. Among individuals with reported NSAID ADRs, 49.5% received inpatient opioids in the postpartum period, compared to 34.5% of those with no NSAID ADRs (difference= 15.0%, 95% confidence interval 11.4-18.6%). For patients who received postpartum inpatient opioids, those with NSAID ADRs received a higher total cumulative dose between delivery and hospital discharge (median 30.0 vs 22.5 morphine milligram equivalents [MME] for vaginal deliveries; median 104.4 vs 75.0 MME for cesarean deliveries). The overall proportion of patients receiving an opioid prescription at the time of hospital discharge was higher for patients with NSAID ADRs compared to patients with no NSAID ADRs (39.3% vs 27.2%; difference= 12.1%, 95% confidence interval 8.6-15.6%). Patients with reported NSAID ADRs had higher postpartum inpatient opioid utilization and more frequently received opioid prescriptions at hospital discharge compared tothose without NSAID ADRs, regardless of mode of delivery.

Standardized Order Sets Do Not Eliminate Racial or Ethnic Inequities in Postpartum Pain Management.

To quantify the extent to which a standardized pain management order set reduced racial and ethnic inequities in post-cesarean pain evaluation and management. We conducted a retrospective cohort study to quantify racial and ethnic differences in pain evaluation and management before (July 2014-June 2016) and after implementation of a standardized post-cesarean order set (March 2017-February 2018). Electronic medical records were queried for pain scores >7/10, number of pain assessments, and opioid, nonsteroidal anti-inflammatory drug (NSAID), and acetaminophen doses. Outcomes were grouped into 0 to <24 and 24-48 h postpartum, and stratified by race/ethnicity (Hispanic, non-Hispanic Black [NHB], non-Hispanic White [NHW], Asian, and other), as documented in the electronic health record. Analyses included logistic regression for the categorical outcome of pain score >7 (severe pain), and linear regression, with propensity score adjustment. Main effect and interaction terms were used to calculate the difference-in-difference in pain process and outcome measures between the baseline and follow-up periods. After order set implementation (N=888), severe pain remained more common among NHB patients (% pain scores >7 NHW vs. NHB 0 to <24 h: 22% vs. 33%, p=0.003; 24-48 h: 26% vs. 40%, p<0.001). Among all patients, pain management processes changed after implementation of the order set, with overall fewer assessments, less Opioids, and more nonopioid analgesics. However, racial and ethnic inequities in a number of assessments and in treatment were unchanged (all p for interaction >0.05), with the exception of a modest increase in NSAID doses 24-48 h postpartum for Hispanic patients. A standardized pain management order set reduced overall postpartum opioid use, but did not reduce racial and ethnic disparities in pain evaluation and management. Future work should investigate racial equity-focused education and interventions designed to eliminate disparities in pain management.

The Use of Capacitive and Resistive Energy Transfer in Postpartum Pain Management in Women after Perineal Trauma.

Perineal pain occurs in 97% of women with episiotomy or first- and second-degree perineal tears on the first day after delivery. The study aimed to assess the impact of capacitive and resistive energy transfer (TECAR) on perineal pain and discomfort in the first two postpartum days. The prospective randomized double-blind study was performed with the pain and discomfort assessment using the Visual Analogue Scale at baseline and after both TECAR interventions. Characteristics data, delivery information, and the number of painkillers taken were collected. The assumed significance level was α < 0.05. The study included 121 women with a mean age of 30.7 ± 4.2 years and a median BMI of 26.1 kg/m2 (24.1; 28.9). Pain reduction at rest, when walking, and discomfort reduction when walking were significantly higher in the TECAR group compared to the sham group (p < 0.05). After the first TECAR intervention, significant reduction in all measured parameters was observed in the study group (p < 0.03), whereas in the control group, it was observed in pain and discomfort while sitting (p < 0.04). The amount of ibuprofen taken on the second day was significantly reduced in the study group compared to the first day (p = 0.004). TECAR has been shown to provide more immediate and significant reduction in perineal pain and discomfort.

Anesthesia and postpartum pain management for placenta accreta spectrum: The patient perspective and recommendations for care.

Placenta accreta spectrum (PAS) is a high-risk complication of pregnancy, which often requires complex surgical intervention. There is limited literature on the patient experience during the perioperative period and postpartum pain management for PAS. Therefore, this study aims to explore the patient perspective of anesthesia care. Ethical approval was granted by the hospital ethics committee (EC02.2023). This was a descriptive survey study, including women with a history of pregnancy complicated by PAS who were members of two patient advocacy groups. The survey, consisting of both open and closed questions, was performed over a 6-week period between January and March 2023. Content analysis was performed on qualitative data to identify themes, and recommendations for care are suggested. A total of 347 participants responded to the survey; 76% (n = 252) had a cesarean hysterectomy (n = 252), and general anesthesia was the most common primary mode of anesthesia (39%, n = 130). We identified two overarching themes: experiences of anesthesia and experience of postpartum pain management. Under experiences of anesthesia, three subthemes were identified, namely "communication with the anesthesiologist", "deferring to the expertise of the team", and "consequences of decision around the mode of anesthesia." Under postpartum pain management, two subthemes emerged: "support of specialist PAS team" and "poor pain management following PAS surgery". Women want to be involved in decisions around their care, but do not always understand the consequences of their decision-making, such as missing the birth of their child. An antenatal anesthesiology consultation is important to provide women with information, explore preferences, and develop a plan of care for the birth.

Anesthesia and postpartum pain management for placenta accreta spectrum: The healthcare provider perspective.

To explore the management and experiences of healthcare providers around anesthetic care in placenta accreta spectrum (PAS). This descriptive survey study was carried out over a 6-week period between January and March 2023. Healthcare providers, both anesthesiologists and those involved in operative care for women with PAS, were invited to participate. Questions invited both quantitative and qualitative responses. Qualitative responses were analyzed using content analysis. In all, 171 healthcare providers responded to the survey, the majority of whom were working in tertiary PAS referral centers (153; 89%) and 116 (70%) had more than 10 years of clinical experience. There was variation in the preferred primary mode of anesthesia for PAS cases; 69 (42%) used neuraxial only, but 58 (35%) used a combined approach of neuraxial and general anesthesia, with only 12 (8%) preferring general anesthesia. Ninety-nine (61%) were offering a routine antenatal anesthesia consultation. Content analysis of qualitative data identified three main themes, which were "variation in approach to primary mode of anesthesia", "perspectives of patient preferences", and "importance of multidisciplinary team care". These findings led to the development of a decision aid provided as part of this paper, which may assist clinicians in counseling women on their options for care to come to an informed decision. Approach to anesthesia for PAS varied between healthcare providers. The final decision for anesthesia should take into consideration the clinical care needs as well as the preferences of the patient.

Associations Between Postpartum Pain Type, Pain Intensity and Opioid Use in Patients With and Without Opioid Use Disorder: A Cross-sectional Study

(British Journal of Anaesthesia. 2023;130:94e102) Pain is a sensory, cognitive, and emotional experience and is affected by a number of biological, psychological, and social factors. Postpartum pain assessment and management remain limited to a one-size-fits-all approach, despite the wide range of pain experiences and types. Patients with opioid use disorder (OUD) may have more complex pain experiences and are at increased risk of severe post-traumatic pain, postoperative complications, readmission, and overdose than those without OUD. The over-prescribing of opioids for postpartum pain management is mitigated by recent efforts to promote shared-decision making. However, overly conservative prescribing practices or poorly managed pain can lead to negative outcomes. This study aimed to investigate the associations between pain type, pain intensity and opioid use during hospital stay, and examine the way pain type influences pain intensity and opioid use among people with and without OUD.

Understanding the Postpartum Cesarean Pain Experience Among Individuals With Publicly Funded Insurance: A Qualitative Investigation.

Pain is the most common postpartum concern and has been associated with adverse outcomes, such as difficulty with neonatal bonding, postpartum depression, and persistent pain. Furthermore, racial and ethnic disparities in the management of postpartum pain are well described. Despite this, less is known regarding patients' lived experiences regrading postpartum pain. The purpose of this study was to assess patient experiences related to postpartum pain management after cesarean birth. This is a prospective qualitative study of patients' experiences with postpartum pain management after cesarean birth at a single large tertiary care center. Individuals were eligible if they had publicly funded prenatal care, were English or Spanish speaking, and underwent a cesarean birth. Purposive sampling was used to ensure a racially and ethnically diverse cohort. Participants underwent in-depth interviews using a semistructured interview guide at 2 time points: postpartum day 2 to 3 and 2 to 4 weeks after discharge. Interviews addressed perceptions and experiences of postpartum pain management and recovery. Data were analyzed using the constant comparative method. Of 49 participants, 40.8% identified as non-Hispanic Black and 40.8% as Hispanic. The majority (59.2%) had experienced a cesarean birth with a prior pregnancy. Thematic analysis yielded 2 overarching domains: (1) experience of pain after cesarean birth and (2) pain management and opioid use after cesarean birth. Themes related to the experience of pain included pain as a meaningful experience, pain not aligned with expectations, and limitations caused by pain. All participants discussed limitations caused by their pain, voicing frustration with pursuing activities of daily living, caring for home and family, caring for neonate, and impact on mood. Themes related to pain management and opioid use addressed a desire for nonpharmacologic pain management, positive and negative experiences using opioids, and hesitancy and perceived judgement regarding opioid use. Several participants described experiences of judgement regarding the request for opioids and needing stronger pain medications, such as oxycodone. Understanding experiences regarding postpartum cesarean pain management and recovery is essential to improving patient-centered care. The experiences identified by this analysis highlight the need for individualized postpartum pain management, improved expectation counseling, and the expansion of multimodal pain management options.

Review of racial/ethnic disparities in obstetrics-related anesthesia administration and pain management.

While racial/ethnic disparities in maternal outcomes including mortality and severe maternal morbidity are well documented, there is limited information on disparities in obstetric anesthesia practices. This paper reviews literature on racial/ethnic disparities in peripartum anesthesia administration and postpartum pain management. Current literature demonstrates racial/ethnic disparities in several aspects of obstetric anesthesia care including neuraxial administration for vaginal labor pain, neuraxial versus general anesthesia for cesarean delivery, post neuraxial anesthesia complications, postpartum pain management and postdural puncture headache treatment practices. However, many studies are dated or have limited data from single institutions or states. More research on nation-wide racial/ethnic disparities in obstetric anesthesia is needed to understand its broader practice and management in the USA.

Use of Opioid-Sparing Protocols and Perceived Postpartum Pain in Patients with Opioid Use Disorder and Chronic Prenatal Opioid Exposure.

Opioid-sparing protocols reduce postpartum opioid prescribing in opioid-naïve patients; however, patients with opioid use disorder (OUD) and complex pain needs who may benefit from these protocols are typically excluded from them. We assessed postpartum pain experiences of patients with OUD and chronic prenatal opioid exposure after implementation of an opioid-sparing protocol. A phone survey assessed postpartum pain experiences for people with chronic prenatal opioid exposure who delivered between January 2020 and August 2021 at an academic hospital. Analyses included descriptive statistics, qualitative content analysis, and a joint display comparing themes. Of 25 patients, 18 (72%) participated; most were non-Hispanic White (100%, 18/18), publicly insured (78%, 14/18), multiparous (78%, 14/18), with OUD (100%, 18/18). No patients with a vaginal birth received an opioid prescription; half (4/8) with a cesarean birth received one at discharge. Over one-third (7/18, 39%) reported poor pain control (≥ 5/10) in the hospital and one week post-discharge; scores were higher for cesarean versus vaginal birth. Qualitative sub-analyses of open-ended responses revealed patient perceptions of postpartum pain and treatment. The most effective strategies, stratified by birth type and pain level, ranged from non-opioid medications for vaginal births and minor pain to prescription opioids for cesarean births and moderate-to-intense pain. Postpartum opioid prescribing for patients with chronic prenatal opioid use was low for vaginal and cesarean birth following implementation of an opioid-sparing protocol. Patients with OUD reported good pain management with opioid-sparing pain regimens; however, many reported poorly controlled pain immediately postpartum. Future work should assess approaches to postpartum pain management that minimize the risks of opioid medication-particularly in at-risk groups.

Racial and ethnic disparities in obstetric anesthesia: a scoping review.

Health disparities continue to affect racial and ethnic marginalized obstetric patients disproportionally with increased risk of Cesarean delivery and pregnancy-related death. Yet, the literature on what influences such disparities in obstetric anesthesia service and its clinical outcomes is less well known. We set out to describe racial and ethnic disparities in obstetric anesthesia during the peripartum period in the USA via a scoping review of the recent literature. Using the Institute of Medicine's definition of disparities, we searched the National Library of Medicine's PubMed/Medline, Embase, Web of Science, APA PsycINFO, and Google Scholar for articles published between 1 January 2000 and 30 June 2022 to identify literature on racial and ethnic disparities in obstetric anesthesia. Out of 8,432 articles reviewed, 15 met our inclusion criteria. All but one study was observational. Seven studies were single-institutional while the remaining used multicentre data/databases. All studies compared two or more race and ethnicity classifications. Studies in this review described disparities in the use of labour epidural analgesia, labour epidural request timing, anesthesia for Cesarean deliveries, postpartum pain management, and epidural blood patch for postdural puncture headaches. Several studies reported disparities observed in the unadjusted models becoming no longer significant when adjusted for other covariates. Based on the findings of the present scoping review on racial and ethnic disparities in obstetric anesthesia, we present an evidence map identifying knowledge gaps and propose a future research agenda.