Nonopioid Versus Opioid Analgesia After Hospital Discharge Following Cesarean Delivery: A Randomized Equivalence Trial

Objective To determine whether pain score after cesarean delivery is equivalent among women receiving outpatient nonopioid vs opioid analgesics. Study design In this trial 170 women with cesarean delivery were randomized to outpatient ibuprofen plus acetaminophen (nonopioid, n=85) or ibuprofen plus hydrocodone-acetaminophen (opioid, n=85). Primary outcome was pain score on a visual analog scale at 2–4 weeks postpartum, which was obtained from 149 (88%) women. Treatments were considered equivalent if the difference between the mean pain scores of each group and its 95% confidence interval were between –10 and 10 mm. A zero-inflated negative binomial model was used to estimate the difference between group means. Results Treatments were not equivalent; mean pain score was lower (better) in the nonopioid group (12.3±19.5 vs 15.9±20.4 mm, adjusted mean difference, 4.8; 95% CI, –2.1 to 11.9 mm). Conclusion Pain score 2–4 weeks after cesarean delivery was lower in women receiving nonopioid analgesics.