Women prescribed opioids that met their personal needs following caesarean section delivery show significant reductions in both the amount of opioids used and in the amount unused, compared with standard post-caesarean opioid prescribing, according to research presented here at the 2018 Annual Meeting of the American College of Obstetricians and Gynecologists (ACOG).
Sarah Osmundson, MD, Vanderbilt University, Nashville, Tennessee, and colleagues have previously shown that most women who undergo caesarean section delivery are prescribed more narcotic pain medications than needed upon discharge.
The current study included 190 women aged 18 years and older who were undergoing a caesarean delivery between June 2017 and August 2017. The study excluded women with complicated caesarean deliveries or who had chronic opioid use.
Patients were approached on postoperative day 1 for informed consent, and were then randomised to either a standard post-discharge opioid prescription (30 tablets of oxycodone 5 mg) or to a customised prescription based on inpatient opioid use and previous research.
The patients were contacted on postoperative day 14 and asked about their pain and opioid tablets used, and the Tennessee Controlled Substance Monitoring Database was accessed to confirm the number of opioids that were dispensed.
With 18 (9.5%) patients lost to follow-up, the remaining 87 patients in the customised group and 85 patients in the standard prescription group reported similar proportions of unused opioids in the final analysis (74.4% vs 70.6%; P= .74).
However, the customised prescription group received half as many opioid tablets as the standard group (14 [interquartile range [IQR] = 12-16] vs 30) and used significantly fewer opioids (8 [IQR = 4-14] vs 15 [IQR = 6-30]; P< .001).
Patients in the customised prescription group also had half as many unused tablets left over (5 [IQR = 1-8] vs 10 [IQR = 0-22]; P< .001).
There were no significant differences between the 2 groups in terms of reported pain outcomes or in analgesic satisfaction.
[Presentation title: Standard vs Customized Post-Cesarean Opioid Prescription: a Randomized Controlled Trial to Reduce Unused Opioids. Abstract 39H]