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Multimodal analgesia reduces opioid use for post-cesarean section pain

A multimodal analgesia approach decreased the amount of opioids prescribed at discharge, adequately controlled pain and reduced hospital length of stay among women after cesarean section, according to data presented at PainWeek 2018.

“Controlling pain in the post-cesarean patient population is particularly important because the immobility caused by the pain further increases these women’s risk for thromboembolic events beyond their already increased baseline risk,” Lelas Shamaileh, PharmD and MS Nutrition candidate from Mount Sinai Hospital, and colleagues wrote. “Additionally, uncontrolled pain may negatively affect mother-baby bonding and can increase risk for postpartum depression and anxiety.”

Shamaileh and colleagues conducted a retrospective chart review to investigate the effectiveness of multimodal analgesia management for controlling pain among women post-cesarean section compared with traditional management with opioids.

The multimodal approach used non-opioid medications, including NSAIDs, acetaminophen and gabapentin. Patients received hydromorphone when their pain score was 7 or more on a 10-point scale. A total of 155 patients received traditional management and 166 patients received multimodal analgesia management.

Results indicated that the average morphine equivalents prescribed inpatient were 44.9 mg before the multimodal approach was implemented, and 23.5 mg post-implementation.

Most patients receiving traditional management (89%) were prescribed opioids upon discharge compared with 32.5% of patients receiving multimodal management, corresponding to a 52% decrease in opioids prescribed at discharge.

Additionally, women in the multimodal analgesia group had a 0.5 day decline in the length of hospital stay.

“The positive results can possibly impact the war against opioid addiction and has substantial economic benefits,” Shamaileh and colleagues concluded. “The reduction in length of stay translates to a projected annual savings of $4.8 million for our institution.” – by Alaina Tedesco

Reference:

Shamaileh L, et al. Battling the opioid epidemic: Use of multi-modal analgesia in women post-cesarean section. Presented at: PAINWeek 2018; Sept. 4-9; Las Vegas.

Disclosure: Healio Internal Medicine was unable to confirm relevant financial disclosures at the time of publication.