OBJECTIVE: To examine the impact of a 24-hour post-cesarean section patient-controlled epidural analgesia (PCEA) in women with opioid use disorder (OUD). Subjective pain scores and quantitative request for and use of opioid medications were compared between the PCEA group and the standard care group. STUDY DESIGN: A retrospective chart review was performed including women who received a PCEA for 24 hours following c-section at an urban academic hospital July 2016-November 2019. Collected data included demographics, pain scores, and morphine-equivalent medications received both inpatient and on discharge. RESULTS: 42 patients with OUD were included in the analysis with 13 in the PCEA group and 29 in the standard care group. There were no significant intergroup differences in age, parity, BMI, or co-morbidities. Compared to the standard care group, the PCEA group reported lower pain scores on postoperative days 0-3 (all p<0.05) and received a significantly lower quantity of opioid medications on postoperative day 1 (6.85 vs 24.58mg, p¼0.003). Quantity of morphine equivalents received were lower on postoperative days 0, 2 and 3, but did not reach statistical significance. The PCEA group had fewer PRN requests for opioid medications on postoperative days 0 and 1 (0 vs 3.36, p¼0.021 and 0.40 vs 2.21, p¼0.001) and were discharged home with a significantly lower quantity of opioid medications (1.77 vs 8.10 tablets, p¼0.01). There were no intergroup differences in complication rates. CONCLUSION: Use of a post-caesarian PCEA was associated with reduced pain scores, fewer requests for PRN opioid medications, lower morphine equivalents received inpatient, and decreased amount of discharge opioid tablets without effect on length of stay or postoperative complications. Our novel protocol presents a pain management plan that may improve postoperative pain control while deferring use of opioid-based analgesics. Further larger and randomized controlled trials should be performed to further investigate this finding.
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