843 A comparison of acute pain management strategies after cesarean delivery

ABSTRACT Background There are approximately 1.2 million cesarean deliveries performed each year, and while traditional postoperative pain management strategies previously relied heavily on opioids, practitioners are now moving toward opioid-sparing protocols using multiple classes of non-narcotic analgesics. Multimodal pain management systems have been adopted by other surgical specialties, including gynecology, though data regarding use for postoperative cesarean delivery pain management remains limited. Objective To determine if a multimodal pain management regimen after cesarean delivery reduces the number of morphine milligram equivalents (MME, a unit of measurement for opioids) compared to traditional patient controlled opioid analgesia (PCA) while adequately controlling postoperative pain. Study Design This was a prospective cohort study of postoperative pain management for women undergoing cesarean delivery at a large county hospital during a transition from a traditional morphine PCA to a multimodal regimen that included scheduled nonsteroidal anti-inflammatory drugs and acetaminophen, with opioids as needed. Data was collected for a 6-week period before and after the transition. The primary outcome was postoperative opioid, use defined as MME, in the first 48 hours. Secondary outcomes included serial pain scores, time to discharge, and exclusive breastfeeding rates. Women who required general anesthesia or who had a history of substance abuse disorder were excluded. Statistical analysis included Student’s t test, Wilcoxon rank sum and Hodges-Lehman shift, with p-value Results During the study period 877 women underwent cesarean delivery and 778 met inclusion criteria: 378 received the traditional PCA and 400 received the multimodal regimen. Implementation of a multimodal regimen resulted in a significant reduction in MME use in the first 48 hours (28 [14,41] MME vs 128 [86,174] MME, p ≤ 4 by 48 hours (88% vs 77%, p Conclusions Transition to a multimodal pain management regimen for women undergoing cesarean delivery resulted in decreased opioid use while adequately controlling postoperative pain. A multimodal regimen was associated with early successful exclusive breastfeeding.