A comparison of acute pain management strategies after cesarean delivery

Macias, Devin A.; Adhikari, Emily H.; Eddins, Michelle; Nelson, David B.; McIntire, Donald D.; Duryea, Elaine L.

doi:10.1016/j.ajog.2021.09.003

Cited by 10 publications

(8 citation statements)

References 29 publications

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“…The 8 studies that evaluated multimodal stepwise interventions were all retrospective cohort studies 16–23 and included initiating scheduled ibuprofen and acetaminophen, with the administration of an opioid on an as‐needed basis for breakthrough pain. These interventions include multiple changes in a bundled fashion and specified stepwise approaches.…”

Section: Resultsmentioning

confidence: 99%

“…Sixteen studies identified interventions to reduce postpartum opioid use during the inpatient period. The majority included implementation of multimodal stepwise protocols (n = 8) [16][17][18][19][20][21][22][23] or changes in dosages or timing of medication administration (n = 4). [24][25][26][27] Four additional studies included interventions that compared nonopioid medication with placebo, 28 use of lidocaine patches, 29 abdominal binder, 30 and battlefield acupuncture, in which needles are placed only on the surface of the ear (Table 1 ).…”

Section: Interventions To Reduce Postpartum Opioid Use During the Inp...mentioning

confidence: 99%

“…[24][25][26][27] Four additional studies included interventions that compared nonopioid medication with placebo, 28 use of lidocaine patches, 29 abdominal binder, 30 and battlefield acupuncture, in which needles are placed only on the surface of the ear (Table 1 ). 31 The 8 studies that evaluated multimodal stepwise interventions were all retrospective cohort studies [16][17][18][19][20][21][22][23] and included initiating scheduled ibuprofen and acetaminophen, with the administration of an opioid on an as-needed basis for breakthrough pain. These interventions include multiple changes in a bundled fashion and specified stepwise approaches.…”

Section: Interventions To Reduce Postpartum Opioid Use During the Inp...mentioning

confidence: 99%

“…Macias (2021) 23 Prospective cohort studyCesarean 778 Preintervention: Morphine 1 mg patient-controlled IV every 6 min as needed, morphine 4mg nurse-administered IV as needed for pain scores ≥7/10, and ibuprofen 600 mg every 6 h for the first 12 h scheduled, followed by continued ibuprofen 600 mg every 6 h scheduled with hydrocodone-acetaminophen 5 mg/325 mg every 4 h as needed for pain scores ≥4/10. Postintervention: 1 dose of ketorolac 30 mg IV and acetaminophen 1000 mg upon arrival to recovery room.…”

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confidence: 99%

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Interventions to Reduce Inpatient and Discharge Opioid Prescribing for Postpartum Patients: A Systematic Review

Badreldin

DiTosto

Holder

et al. 2023

J Midwife Womens Health

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Introduction As deaths related to opioids continue to rise, reducing opioid use for postpartum pain management is an important priority. Thus, we conducted a systematic review of postpartum interventions aimed at reducing opioid use following birth. Methods From database inception through September 1, 2021, we conducted a systematic search in Embase, MEDLINE, Cochrane Library, and Scopus including the following Medical Subject Heading (MeSH) terms: postpartum, pain management, opioid prescribing. Studies published in English, restricted to the United States, and evaluating interventions initiated following birth with outcomes including an assessment of change in opioid prescribing or use during the postpartum period (<8 weeks postpartum) were included. Authors independently screened abstracts and full articles for inclusion, extracted data, and assessed study quality using the Grading of Recommendations, Assessment, Development, and Evaluation tool and risk of bias using the Institutes of Health Quality Assessment Tools. Results A total of 24 studies met inclusion criteria. Sixteen studies evaluated interventions aimed at reducing postpartum opioid use during the inpatient hospitalization, and 10 studies evaluated interventions aimed at reducing opioid prescribing at postpartum discharge. Inpatient interventions included changes to standard order sets and protocols for the management of pain after cesarean birth. Such interventions resulted in significant decreases in inpatient postpartum opioid use in all but one study. Additional inpatient interventions, including use of lidocaine patches, postoperative abdominal binder, valdecoxib, and acupuncture were not found to be effective in reducing postpartum opioid use during inpatient hospitalization. Interventions targeting the postpartum period included individualized prescribing and state legislative changes limiting the duration of opioid prescribing for acute pain both resulted in decreased opioid prescribing or opioid use. Discussion A variety of interventions aimed at reducing opioid use following birth have shown efficacy. Although it is not known if any single intervention is most effective, these data suggest that implementation of any number of interventions may be advantageous in reducing postpartum opioid use.

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Section: Resultsmentioning

confidence: 99%

Section: Interventions To Reduce Postpartum Opioid Use During the Inp...mentioning

confidence: 99%

Section: Interventions To Reduce Postpartum Opioid Use During the Inp...mentioning

confidence: 99%

mentioning

confidence: 99%

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Interventions to Reduce Inpatient and Discharge Opioid Prescribing for Postpartum Patients: A Systematic Review

Badreldin

DiTosto

Holder

et al. 2023

J Midwife Womens Health

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“…In 2021, the cesarean birth rate rose to 32.1% from 31.8% in 2020 (Hamilton et al, 2022). With over 1.2 million cesareans performed in the United States each year who are prescribed opioid analgesia during an inpatient cesarean stay and discharge, there are a signifi cant number of women who could become potential persistent users (Macias et al, 2022). Inadequate treatment of cesarean pain in the early recovery phase can result in increased opioid use (Carvalho & Butwick, 2017).…”

mentioning

confidence: 99%

A Multimodal Protocol to Limit Opioid Exposure and Effectively Manage Postoperative Cesarean Birth Pain

Harden

Dawkins

Stallings-Saints

et al. 2023

McN: The American Journal of Maternal/Child Nursing

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To evaluate the impact of implementing a multimodal plan of care in treating the pain of the postoperative cesarean birth patient that limited opioid exposure. Study Design and Methods: A retrospective medical record review was conducted to evaluate a pain management protocol implemented for postoperative cesarean patients before and after a practice change. Sample included term postoperative cesarean patients ≥ 37 weeks of gestation, who had spinal or epidural, were 18 years or older, gave birth to a singleton newborn, admitted to the maternal child health department, and were prescribed opioids as a postoperative pain management treatment plan. Participants (N = 150) were evaluated based on two groups: n = 75 in the preimplementation group and n = 75 in the postimplementation group. Results: There was a signifi cant difference in the total oral opioid milligrams administered between the pregroup (M = 27.13) and postgroup (M = 8.43), after the practice change (p < .001). There was an increase of nonopioids administered to treat and manage postoperative cesarean pain, Motrin PO (p = < .001) and Tylenol PO (p = .002). Clinical Implications: Fewer milligram equivalents of morphine were administered when postoperative cesarean patients were placed on scheduled nonopioids to treat pain.

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Cesarean Delivery

Duryea

2023

Queenan's Management of High‐Risk Pregnancy

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A comparison of acute pain management strategies after cesarean delivery

Cited by 10 publications

References 29 publications

Interventions to Reduce Inpatient and Discharge Opioid Prescribing for Postpartum Patients: A Systematic Review

Interventions to Reduce Inpatient and Discharge Opioid Prescribing for Postpartum Patients: A Systematic Review

A Multimodal Protocol to Limit Opioid Exposure and Effectively Manage Postoperative Cesarean Birth Pain

Cesarean Delivery

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