Multimodal stepwise analgesia for reducing opioid consumption after cesarean delivery
Background: Opioid over-prescription after cesarean delivery (CD) delays postoperative recovery, interferes with breastfeeding and may prompt persistent opioid use after hospital discharge. We evaluated the effects of implementing a multimodal stepwise analgesic regimen on opioid consumption and pai...
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| Format: | Article |
| Language: | English |
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IMR Press
2021-10-01
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| Series: | Clinical and Experimental Obstetrics & Gynecology |
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| Online Access: | https://www.imrpress.com/journal/CEOG/48/5/10.31083/j.ceog4805186 |
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| author | Uros Visic Tatjana Stopar Pintaric Tit Albreht Iva Blajic Miha Lucovnik |
| author_facet | Uros Visic Tatjana Stopar Pintaric Tit Albreht Iva Blajic Miha Lucovnik |
| author_sort | Uros Visic |
| collection | DOAJ |
| description | Background: Opioid over-prescription after cesarean delivery (CD) delays postoperative recovery, interferes with breastfeeding and may prompt persistent opioid use after hospital discharge. We evaluated the effects of implementing a multimodal stepwise analgesic regimen on opioid consumption and pain scores after CD. Methods: This was a retrospective before-after study. Opioid intake (expressed as morphine milligram equivalents (MME)) and pain scores (using the 11-point numerical rating score) within 24-hours following planned cesarean delivery under spinal anesthesia without intrathecal morphine were compared before vs. after change in post-cesarean analgesia regimen. This included intensified non-opioid analgesia with quadratus lumborum block and shifting from scheduled to as-needed opioids. Mann-Whitney U test was used for statistical comparison (p < 0.05 was considered statistically significant). Results: We included 116 women: 58 in pre-intervention and 58 in post-intervention group. There was an 86% reduction in MME (median 14 (interquarile range (IQR) 14–18) mg pre-intervention vs. 2 (IQR 2–4) mg post-intervention; p < 0.001). Pain scores were statistically higher at 2 and 4 hours post-CD in the post-intervention group (1 (IQR 1–2) vs. 2 (IQR 1–3); p = 0.001, and 2 (IQR 1–3) vs. 2 (IQR 2–3); p = 0.03, respectively) but lower at 6 hours post-CD (3 (IQR 2–4) vs. 2 (IQR 2–3); p = 0.02). No statistically significant difference in pain scores at 1, 12 and 24 hours post-CD were observed. Conclusion: Multimodal stepwise analgesic regimen allowed shifting from scheduled to as-needed opioids for post-CD pain management without increase in pain scores. This resulted in significant reduction in opioid consumption after CD. |
| format | Article |
| id | doaj-art-229cc477c8e34cfb89f0f8a0331d50ef |
| institution | OA Journals |
| issn | 0390-6663 |
| language | English |
| publishDate | 2021-10-01 |
| publisher | IMR Press |
| record_format | Article |
| series | Clinical and Experimental Obstetrics & Gynecology |
| spelling | doaj-art-229cc477c8e34cfb89f0f8a0331d50ef2025-08-20T01:58:49ZengIMR PressClinical and Experimental Obstetrics & Gynecology0390-66632021-10-014851162116610.31083/j.ceog4805186S0390-6663(21)00024-5Multimodal stepwise analgesia for reducing opioid consumption after cesarean deliveryUros Visic0Tatjana Stopar Pintaric1Tit Albreht2Iva Blajic3Miha Lucovnik4Department of Perinatology, Division of Obstetrics and Gynecology, University Medical Centre Ljubljana, 1000 Ljubljana, SloveniaDepartment of Anesthesiology and Intensive Therapy, University Medical Centre Ljubljana, 1000 Ljubljana, SloveniaNational Institute of Public Health, 1000 Ljubljana, SloveniaDepartment of Anesthesiology and Intensive Therapy, University Medical Centre Ljubljana, 1000 Ljubljana, SloveniaDepartment of Perinatology, Division of Obstetrics and Gynecology, University Medical Centre Ljubljana, 1000 Ljubljana, SloveniaBackground: Opioid over-prescription after cesarean delivery (CD) delays postoperative recovery, interferes with breastfeeding and may prompt persistent opioid use after hospital discharge. We evaluated the effects of implementing a multimodal stepwise analgesic regimen on opioid consumption and pain scores after CD. Methods: This was a retrospective before-after study. Opioid intake (expressed as morphine milligram equivalents (MME)) and pain scores (using the 11-point numerical rating score) within 24-hours following planned cesarean delivery under spinal anesthesia without intrathecal morphine were compared before vs. after change in post-cesarean analgesia regimen. This included intensified non-opioid analgesia with quadratus lumborum block and shifting from scheduled to as-needed opioids. Mann-Whitney U test was used for statistical comparison (p < 0.05 was considered statistically significant). Results: We included 116 women: 58 in pre-intervention and 58 in post-intervention group. There was an 86% reduction in MME (median 14 (interquarile range (IQR) 14–18) mg pre-intervention vs. 2 (IQR 2–4) mg post-intervention; p < 0.001). Pain scores were statistically higher at 2 and 4 hours post-CD in the post-intervention group (1 (IQR 1–2) vs. 2 (IQR 1–3); p = 0.001, and 2 (IQR 1–3) vs. 2 (IQR 2–3); p = 0.03, respectively) but lower at 6 hours post-CD (3 (IQR 2–4) vs. 2 (IQR 2–3); p = 0.02). No statistically significant difference in pain scores at 1, 12 and 24 hours post-CD were observed. Conclusion: Multimodal stepwise analgesic regimen allowed shifting from scheduled to as-needed opioids for post-CD pain management without increase in pain scores. This resulted in significant reduction in opioid consumption after CD.https://www.imrpress.com/journal/CEOG/48/5/10.31083/j.ceog4805186analgesiacesarean deliverycesarean sectionopioidsregional anesthesia |
| spellingShingle | Uros Visic Tatjana Stopar Pintaric Tit Albreht Iva Blajic Miha Lucovnik Multimodal stepwise analgesia for reducing opioid consumption after cesarean delivery Clinical and Experimental Obstetrics & Gynecology analgesia cesarean delivery cesarean section opioids regional anesthesia |
| title | Multimodal stepwise analgesia for reducing opioid consumption after cesarean delivery |
| title_full | Multimodal stepwise analgesia for reducing opioid consumption after cesarean delivery |
| title_fullStr | Multimodal stepwise analgesia for reducing opioid consumption after cesarean delivery |
| title_full_unstemmed | Multimodal stepwise analgesia for reducing opioid consumption after cesarean delivery |
| title_short | Multimodal stepwise analgesia for reducing opioid consumption after cesarean delivery |
| title_sort | multimodal stepwise analgesia for reducing opioid consumption after cesarean delivery |
| topic | analgesia cesarean delivery cesarean section opioids regional anesthesia |
| url | https://www.imrpress.com/journal/CEOG/48/5/10.31083/j.ceog4805186 |
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