Should opioids not be prescribed for post-cesarean delivery pain?

  • Dinis J & al.
  • Am J Obstet Gynecol
  • 06.12.2019

  • von Elisabeth Aron, MD, MPH, FACOG
  • Clinical Essentials
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Takeaway

  • Opioid use does not improve pain scores or patient satisfaction scores after hospital discharge for cesarean delivery (CD).

Why this matters

  • The opioid epidemic is a major public health concern.
  • 1 in 300 opioid-naive women given an opioid prescription may become chronic users.
  • Leftover opioid prescriptions are a source for opioid abuse.

Key results

  • Mean visual analog scale (VAS) pain scores at the 2-4-week visit were lower in the nonopioid group compared with the opioid group (adjusted mean difference, 4.89; 95% CI, −2.19 to 11.96).
  • Outpatient ibuprofen use was similar between groups.
  • Satisfaction scores were similar between groups.

Study design

  • Randomized, parallel-group, equivalence trial at a single center.
  • Women who underwent CD were invited to participate on the inpatient postpartum floor.
  • The opioid group received a prescription for ibuprofen and 15 tablets of hydrocodone-acetaminophen (5/325 mg) to take every 4-6 hours (n=85) vs the nonopioid group who received a prescription for ibuprofen and counseling on how to take acetaminophen (n=85).
  • Primary outcome was a mean pain score using a VAS at a 2-4-week postpartum visit.
  • Funding: None disclosed.

Limitations

  • Participants were not blinded to the intervention.
  • Pain scores were assessed at 2-4 weeks postpartum.