Evaluation of a Quality Improvement Intervention That Eliminated Routine Use of Opioids After Cesarean Delivery

Holland, Erica; Bateman, Brian T.; Cole, Naida M.; Taggart, Ashley; Robinson, Laura A; Sugrue, Ronan; Xu, Xinling; Robinson, Julian N.

doi:10.1097/aog.0000000000003010

Cited by 61 publications

(72 citation statements)

References 15 publications

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“…27 More recently, opioid-free protocols have been used following cesarean delivery, with more than 50% of enrolled patients able to navigate the postpartum period without any opioids. 36…”

Section: Discussionmentioning

confidence: 99%

Rates of New Persistent Opioid Use After Vaginal or Cesarean Birth Among US Women

et al. 2019

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IMPORTANCE Research has shown an association between opioid prescribing after major or minor procedures and new persistent opioid use. However, the association of opioid prescribing with persistent use among women after vaginal delivery or cesarean delivery is less clear. OBJECTIVE To assess the association between opioid prescribing administered for vaginal or cesarean delivery and rates of new persistent opioid use among women. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study used national insurance claims data for 988 036 women from a single private payer from January 1, 2008, to December 31, 2016. Participants included reproductive age, opioid-naive women with 1 year of continuous enrollment before and after delivery. For participants with multiple births, only the first birth was included. EXPOSURES Peripartum opioid prescription (1 week before delivery to 3 days after discharge) captured by pharmacy claims, including prescription timing and size in oral morphine equivalents. Multivariable adjusted odds ratios were estimated using regression models. MAIN OUTCOMES AND MEASURES Rates of new persistent opioid use, defined as pharmacy claims for 1 or more opioid prescription 4 to 90 days after discharge and 1 or more prescription 91 to 365 days after discharge among women who filled peripartum opioid prescriptions. RESULTS In total, 308 226 deliveries were included: 195 013 (63.3%) vaginal deliveries and 113 213 (36.7%) cesarean deliveries. Participant mean (SD) age was 31.3 (5.3) years, and 70 567 (51.0%) were white patients. Peripartum opioid prescriptions were filled by 27.0% of women with vaginal deliveries and 75.7% of women with cesarean deliveries. Among them, 1.7% of those with vaginal deliveries and 2.2% with cesarean deliveries had new persistent opioid use. By contrast, among women not receiving a peripartum opioid prescription, 0.

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“…27 More recently, opioid-free protocols have been used following cesarean delivery, with more than 50% of enrolled patients able to navigate the postpartum period without any opioids. 36…”

Section: Discussionmentioning

confidence: 99%

Rates of New Persistent Opioid Use After Vaginal or Cesarean Birth Among US Women

et al. 2019

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“…Holland et al 8 examined the effect of discontinuing routine opioid prescription after cesarian sections. The number of patients receiving opioid medication during the hospitalization decreased from 68% to 45%, with no significant change in pain scores and patient satisfaction with pain control.…”

Section: Discussionmentioning

confidence: 99%

Effect of the Strengthening Opioid Misuse Prevention (STOP) Act on Opioid Prescription Practices After Ankle Fracture Fixation

Hussaini

Wang

Luo

et al. 2019

Foot & Ankle Orthopaedics

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Background: In North Carolina, the Strengthen Opioid Misuse Prevention Act of 2017 (STOP Act) went into effect on January 1, 2018, intending to increase oversight over opioid prescriptions. This study compares postoperative narcotic prescription practices following operative fixation of ankle fractures before and after the STOP Act. Methods: This study was a retrospective review of patients 18 years and older who underwent operative fixation of ankle fractures between January 1 and June 30, 2017 (before STOP Act), and between January 1 and June 30, 2018 (after STOP Act). Variables of interest included demographics, amount of opioids prescribed postoperatively, number of prescription refills, and number of pain-related calls or visits to the emergency department (ED) or clinic after surgery. This study assessed 71 patients in the Pre group and 47 patients in the Post group. Results: There was a statistically significant decrease in the average number of postoperative narcotic pills prescribed after the STOP Act (52.7 vs 76.2, P < .001). There was also a statistically significant decrease in the average number of prescription refills (0.6 vs 1.0, P = .037). There were no significant changes in pain-related clinic calls (35.2% Pre vs 34.0% Post, P = .896), pain-related clinic visits ahead of schedule (4.2% Pre vs 6.4% Post, P = .681), or pain-related ED visits (2.8% Pre vs 10.6% Post, P = .113). Conclusion: In the postoperative period after operative fixation of ankle fractures, the volume of narcotic prescriptions decreased after the new legislation, without an associated strain on medical resources. Level of Evidence: Level III, therapeutic, comparative study.

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“…Hal ini sesuai dengan American College of Obstetricians and Gynecologists merekomendasikan bahwa pemberian opioid sebaiknya hanya sebagai tambahan untuk pasien dengan nyeri yang tidak terkontrol meslkipun pemberian terapi non-opioid lini pertama telah adekuat. 29…”

Section: Opioidunclassified

“…Hal ini dapat mengurangi penggunaan dan efek samping opioid terhadap wanita yang menjalani SS dan bayi yang diberikan ASI. 1,29…”

Section: Analgesia Multimodalunclassified

Manajemen Nyeri Terkini pada Pasien Pasca Seksio Sesarea

Ahmad

Taufik

2021

JAOI

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Prosedur Seksio Sesarea (SS) seringkali menyebabkan nyeri sedang hingga berat selama 48 jam. Tujuan manajemen nyeri pascabedah adalah untuk memberikan kenyamanan pada pasien, menghambat impuls nosiseptif, dan menumpulkan respon neuroendokrin terhadap nyeri, yang dengan demikian mempercepat kembalinya fungsi fisiologis. Selain itu, manajemen nyeri yang adekuat pada pasien SS memungkinkan mobilisasi dini untuk mencegah risiko tromboemboli yang meningkat selama kehamilan dan pasien perlu bebas nyeri untuk merawat bayi serta memberikan ASI secara efektif. Mekanisme nyeri pascabedah terdiri dari sensitisasi perifer dan senstisasi sentral dari susunan saraf. Dampak klinik sensitisasi sistem saraf berupa hiperalgesia dan alodinia. Sensitisasi pascabedah akan mengakibatkan penderitaan bagi pasien sehingga pada akhirnya dapat meningkatkan angka morbiditas dan mortalitas pascabedah, oleh karena itu manajemen nyeri pascabedah harus ditujukan ke arah pencegahan dan meminimalkan terjadinya proses sensitisasi. Analgesia multimodal dengan mengkombinasi obat yang menghambat sensitisasi perifer dan sentral, dengan opioid sebagai analgesia penyelamat dapat menjadi pilihan untuk memberikan manajemen nyeri yang adekuat dan meminimalkan efek samping. Current Practice for Post Operative Pain Management in Caesarean Section Abstract Caesarean section (CS) is frequently followed by moderate to severe pain up to 48 hours after surgery. Postoperative pain management is aimed to provide postoperative comfortness, inhibits nociceptive impulse, and blunts neuroendocrine response to pain, thus enhance the return of physiological function. Moreover, an adequate pain management in CS patients allows early mobilization in preventing the increased of thromboemboli risk during pregnancy, the need of patients to be pain free in taking care of the baby as well as effective breastfeeding. Postoperative pain mechanism consists of peripheral and central senzitisation of nervous system. Clinical impact of nervous system sensitization including hyperalgesia and allodynia. Postoperative sensitization resulted in patient’s suffering that increase morbidity and mortality rate eventually. Therefore, postoperative pain management should be directed to prevent and minimalize sensitization process. Multimodal analgesia by combining analgesics inhibited peripheral and central sensitization, with opioid as rescue analgesic may be preferred to provide adequate pain management and to minimalize the adverse effects.

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Evaluation of a Quality Improvement Intervention That Eliminated Routine Use of Opioids After Cesarean Delivery

Cited by 61 publications

References 15 publications

Rates of New Persistent Opioid Use After Vaginal or Cesarean Birth Among US Women

Rates of New Persistent Opioid Use After Vaginal or Cesarean Birth Among US Women

Effect of the Strengthening Opioid Misuse Prevention (STOP) Act on Opioid Prescription Practices After Ankle Fracture Fixation

Manajemen Nyeri Terkini pada Pasien Pasca Seksio Sesarea

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