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

Abstract

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.

Noninvasive Bioelectronic Treatment of Postcesarean Pain

“…This lower use likely reflects a general focus on decreasing opioid use at OSU Wexner Medical Center as well as nationally. 43 Nevertheless, our study showed a 53% decrease in inpatient postoperative MME use in the active device group. The opioids prescribed at discharge differed by a median of 7.5 MME, which equates to approximately 1 fewer 5-mg oxycodone tablet per individual treated with the functional device.…”

“…This lower use likely reflects a general focus on decreasing opioid use at OSU Wexner Medical Center as well as nationally. 43 Nevertheless, our study showed a 53% decrease in inpatient postoperative MME use in the active device group.…”

Implementation of Regulation About Enhanced Recovery After Caesarean Surgery in Indonesia: A Literature Review

“…These policies have implications for healthcare delivery, including anesthesia services, and highlight the intersection of public health policies and healthcare regulation. The ERACS protocol, endorsed by the Society for Obstetric Anesthesia and Perinatology (SOAP), has been recognized as a pathway for postoperative care in cesarean delivery (Badreldin et al, 2023;Bollag et al, 2021;Macones et al, 2019;Sultan et al, 2022Sultan et al, , 2023Zanolli et al, 2023).…”

Reducing inpatient opioid consumption after caesarean delivery: effects of an opioid stewardship programme and racial impact in a community hospital

“…Despite the simplicity of our opioid stewardship programme, a large retrospective study by Reed et al 16 demonstrated that the majority of patients did not receive multimodal analgesia after caesarean delivery in the USA 16. In addition, current evidence shows that different interventions can effectively reduce postpartum opioid use, but there is no optimal method yet 17. Therefore, we believe our programme applies in different contexts but requires continuous evaluation and adjustments over time.…”

“…16 In addition, current evidence shows that different interventions can effectively reduce postpartum opioid use, but there is no optimal method yet. 17 Therefore, we believe our programme applies in different contexts but requires continuous evaluation and adjustments over time.…”