Impact of Patient Choice for Different Postcesarean Delivery Analgesic Protocols on Opioid Consumption: A Randomized Prospective Clinical Trial

Carvalho, Bruno; Sutton, Christopher; Kowalczyk, John J.; Flood, Pamela

doi:10.1097/01.aoa.0000652960.08788.6d

Cited by 6 publications

(14 citation statements)

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“…Having a choice did not impact on rescue opioid consumption, but women were very good in predicting their actual opioid needs. Choosing high-dose intrathecal morphine was associated with increased rescue analgesia and more vomiting [45,46]. Apart from one study [44], all studies used basic analgesia with NSAIDs [42,43,46] or a combination of NSAIDs and paracetamol [45].…”

Section: Neuraxial Adjuvant Drugsmentioning

confidence: 99%

PROSPECT guideline for elective caesarean section: updated systematic review and procedure‐specific postoperative pain management recommendations

et al. 2020

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Caesarean section is associated with moderate-to-severe postoperative pain, which can influence postoperative recovery and patient satisfaction as well as breastfeeding success and mother-child bonding. The aim of this systematic review was to update the available literature and develop recommendations for optimal pain management after elective caesarean section under neuraxial anaesthesia. A systematic review utilising procedure-specific postoperative pain management (PROSPECT) methodology was undertaken. Randomised controlled trials published in the English language between 1 May 2014 and 22 October 2020 evaluating the effects of analgesic, anaesthetic and surgical interventions were retrieved from MEDLINE, Embase and Cochrane databases. Studies evaluating pain management for emergency or unplanned operative deliveries or caesarean section performed under general anaesthesia were excluded. A total of 145 studies met the inclusion criteria. For patients undergoing elective caesarean section performed under neuraxial anaesthesia, recommendations include intrathecal morphine 50-100 µg or diamorphine 300 µg administered pre-operatively; paracetamol; non-steroidal anti-inflammatory drugs; and intravenous dexamethasone administered after delivery. If intrathecal opioid was not administered, single-injection local anaesthetic wound infiltration; continuous wound local anaesthetic infusion; and/or fascial plane blocks such as transversus abdominis plane or quadratus lumborum blocks are recommended. The postoperative regimen should include regular paracetamol and non-steroidal anti-inflammatory drugs with opioids used for rescue. The surgical technique should include a Joel-Cohen incision; non-closure of the peritoneum; and abdominal binders. Transcutaneous electrical nerve stimulation could be used as analgesic adjunct. Some of the interventions, although effective, carry risks, and consequentially were omitted from the recommendations. Some interventions were not recommended due to insufficient, inconsistent or lack of evidence. Of note, these recommendations may not be applicable to unplanned deliveries or caesarean section performed under general anaesthesia.

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Section: Neuraxial Adjuvant Drugsmentioning

confidence: 99%

PROSPECT guideline for elective caesarean section: updated systematic review and procedure‐specific postoperative pain management recommendations

et al. 2020

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“…e results revealed that patients who requested the larger dose required more supplemental opioids and reported more pain than those who requested the smaller dose. Another study reported similar results, with patients choosing a higher dose (300 mcg intrathecal morphine + single dose oral gabapentin 600 mg) requiring more rescue opioids than those selecting a medium dose (150 mcg) or low dose (50 mcg) [27].…”

Section: Identification Of Women At Risk Of Severe Postoperative Painmentioning

confidence: 69%

The Current Consideration, Approach, and Management in Postcesarean Delivery Pain Control: A Narrative Review

Sangkum

Thamjamrassri

Arnuntasupakul

et al. 2021

Anesthesiology Research and Practice

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Optimal postoperative analgesia has a significant impact on patient recovery and outcomes after cesarean delivery. Multimodal analgesia is the core principle for cesarean delivery and pain management. For a standard analgesic regimen, the use of long-acting neuraxial opioids (e.g., morphine) and adjunct drugs, such as scheduled acetaminophen and nonsteroidal anti-inflammatory drugs, is recommended unless contraindicated. Oral or intravenous opioids should be reserved for breakthrough pain. In addition to the aforementioned use of multimodal analgesia, preoperative evaluation is critical to individualize the analgesic regimen according to the patient requirements. Risk factors for severe postoperative pain or analgesia-related adverse effects will require modifications to the standard analgesic regimen (e.g., the use of ketamine, gabapentinoids, or regional anesthetic techniques). Further investigation is required to determine analgesic drugs or dose alterations based on preoperative predictions for patients at risk of severe pain. Outcomes beyond pain and analgesic use, such as functional recovery, should be determined to evaluate analgesic treatment protocols.

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“…Our results demonstrated that recent surgeries (especially 2015-2020) were strongly associated with the utilization of neuraxial morphine. The trend in neuraxial morphine use is important in establishing benchmarks and could provide invaluable information to help clinicians and patients in shared decision-making for postcesarean delivery analgesia [13].…”

Section: Discussionmentioning

confidence: 99%

The trend in neuraxial morphine use and postoperative analgesia after cesarean delivery in Japan from 2005 to 2020

Yonekura

Mazda

Noguchi

et al. 2022

Preprint

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The increasing rate of cesarean deliveries warrants obstetric anesthesiologists to deliver high-quality post-cesarean delivery analgesia. The aim of this study was to evaluate the temporal trends in the use of neuraxial morphine for cesarean deliveries and to describe the current postoperative analgesia practices. A retrospective cohort study using nationwide health insurance claims databases was conducted from 2005 to 2020 in Japan. Pregnant women who had undergone cesarean deliveries (elective or emergency) were included. The annual rate of neuraxial morphine use was extracted and analyzed. Additionally, we explored the patient- and facility-level factors associated with neuraxial morphine use through a multilevel logistic regression analysis. The cohort included 65,208 cesarean delivery cases (56,307 patients) from 2,275 institutions. The prevalence of neuraxial morphine use was 16.0% in the overall cohort. Intrathecal morphine was used in 20.6% of spinal anesthesia cases. The trend in neuraxial morphine use steadily increased from 2005 to 2020 (P for trend < 0.001). The significant predictors of neuraxial morphine use included spinal anesthesia, recent surgery, large medical facilities, and academic hospitals. There were variations in the utilization of postoperative analgesia. Our study described the current trend of neuraxial morphine use and the variation in postoperative analgesia practice in Japan.

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Impact of Patient Choice for Different Postcesarean Delivery Analgesic Protocols on Opioid Consumption: A Randomized Prospective Clinical Trial

Cited by 6 publications

References 0 publications

PROSPECT guideline for elective caesarean section: updated systematic review and procedure‐specific postoperative pain management recommendations

PROSPECT guideline for elective caesarean section: updated systematic review and procedure‐specific postoperative pain management recommendations

The Current Consideration, Approach, and Management in Postcesarean Delivery Pain Control: A Narrative Review

The trend in neuraxial morphine use and postoperative analgesia after cesarean delivery in Japan from 2005 to 2020

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