Patterns of Opioid Prescription and Use After Cesarean Delivery

Abstract

Objective To define the amount of opioid analgesics prescribed and consumed after discharge after cesarean delivery. Methods We conducted a survey at six academic medical centers in the United States from 9/2014 to 3/2016. Women who had undergone a cesarean delivery were contacted by phone two weeks after discharge and participated in a structured interview about the opioid prescription they received upon discharge and their oral opioid intake while at home. Results A total of 720 women were enrolled; of these, 615 (85.4%) filled an opioid prescription. The median number of dispensed opioid tablets was 40 (interquartile range (IQR) 30 to 40), the median number consumed was 20 (IQR 8 to 30), and leftover was 15 (IQR 3 to 26). Of those with leftover opioids, 95.3% had not disposed of the excess medication at the time of the interview. There was an association between a larger number of tablets dispensed and the number consumed independent of patient characteristics. The amount of opioids dispensed did not correlate with patient satisfaction, pain control, or the need to refill the opioid prescription. Conclusion The amount of opioid prescribed after cesarean delivery generally exceeds the amount consumed by a significant margin, leading to substantial amounts of leftover opioid medication. Lower opioid prescription correlates with lower consumption without a concomitant increase in pain scores or satisfaction.

Opioid Prescribing Patterns, Patient Use, and Postoperative Pain After Hysterectomy for Benign Indications

“…However, recent studies found no association between the amount of opioid prescribed and the likelihood of refill request after surgery 20 , and no association between the initial postoperative prescription, patient satisfaction 8 , or the Hospital Consumer Assessment of Healthcare Providers and Systems pain measure. 21 These findings should reassure surgeons that reducing the amount of opioid provided after surgery should still provide adequate pain management while maintaining patient satisfaction in most patients.…”

“…8,9 However, few studies have examined whether individual patient factors predict outpatient opioid use. One recent study reported that individual in-hospital opioid consumption was correlated with post-discharge opioid use.…”

“…Recent studies have found that most patients undergoing various surgical procedures 4–7 , including cesarean section 8,9 , are prescribed opioids in excess of what they use. Despite the era of personalized medicine, most studies did not investigate whether individual patient factors influence opioid use and postsurgical pain during the postoperative period.…”

Substance use disorders in pregnancy: clinical, ethical, and research imperatives of the opioid epidemic: a report of a joint workshop of the Society for Maternal-Fetal Medicine, American College of Obstetricians and Gynecologists, and American Society of Addiction Medicine

“…Most women (95.3%) did not dispose of their leftover medications. 3 One study reported that 4.7% of pregnant women reported using an illicit substance in the past month. 4 One study reported that 1 in 300 women will become dependent on opioids after a cesarean delivery.…”

Comparison of Postoperative Opioid Consumption and Pain Scores in Primary Versus Repeat Cesarean Delivery in Opioid Naïve Patients

“…This project is the first to suggest a difference in postoperative opioid requirements between patients undergoing primary versus repeat CD. With regard to opioid administration, medical practitioners often prescribe opioids as part of their multimodal analgesic regimen to control postoperative pain after CD [16]. For this study all patients received multi-modal strategies for postoperative pain control, and none received additional regional procedures such as transverse abdominis plane block outside of the spinal anesthetic.…”