Personalized protocol after cesarean delivery reduces outpatient opioid prescriptions

Key takeaways:

• After personalized protocol implementation, fewer patients were prescribed opioids at discharge.
• No patients required hospital readmission or additional opioid prescriptions.

After cesarean delivery, utilizing a personalized protocol for opioid prescriptions reduced the number of opioids prescribed at discharge without affecting hospital readmissions or the need for rescue prescriptions, researchers reported.

“Studies have shown that regardless of objective and subjective measures of pain prior to discharge, patients received similar amount of prescription morphine equivalents following cesarean deliveries,” Chinonye S. Imo, MD, resident physician in the department of obstetrics and gynecology at Parkland Health, Dallas, and colleagues wrote. “Additionally, most patients do not use all the opioids they are prescribed at hospital discharge. Thus, this practice of prescribing a standard number of opioid tablets regardless of in-hospital use leads to an excess of opioids in the community.”

Imo and colleagues conducted a prospective cohort study, published in the American Journal of Obstetrics and Gynecology, with data from 367 women who underwent cesarean delivery before and 412 women who underwent cesarean delivery after personalized opioid prescribing practice implementation at discharge. Before implementation, women were prescribed 30 acetaminophen-codeine 300 mg/30 mg tablets. Those who had cesarean delivery after the implementation were prescribed scheduled ibuprofen and acetaminophen with a prescription for oxycodone tablets equal to five times the morphine equivalents used in the 24 hours before discharge.

The primary outcome was morphine equivalents prescribed at discharge.

With the personalized prescribing technique, the median morphine equivalents prescribed at discharge were lower compared with before implementation (37.5 vs. 135; P < .001). Researchers observed no opioid prescriptions at discharge among 43% of women who underwent cesarean delivery after implementation compared with before implementation, in which all 367 patients had opioid prescriptions (P < .001).

Researchers noted that the hospitals received nine hotline phone calls, but none required additional opioid prescriptions after the 24-hour trial of prescribed scheduled ibuprofen.

Overall, 2.7% of women presented to the ED for pain evaluation, but none required hospital readmission or an outpatient opioid prescription.

“As providers attempt to curtail the amount of opioids prescribed, this practice change at a single institution will result in a reduction in opioids released into our community by over 90,000 tablets per year, without demonstrable adverse effect,” the researchers wrote. “If implemented at a national level, the impact would be meaningful.”