OBJECTIVE The amount of opioid prescribed following cesarean delivery is commonly in excess of patients' needs. An additional concern in a breastfeeding mother is neonatal opioid exposure. A maximum daily… Click to show full abstract
OBJECTIVE The amount of opioid prescribed following cesarean delivery is commonly in excess of patients' needs. An additional concern in a breastfeeding mother is neonatal opioid exposure. A maximum daily dose of 30 mg of oxycodone is recommended in breastfeeding women. Inadequate pain control can inhibit breastfeeding and other negative consequences. We aimed to evaluate the effect of reducing the as-needed opioid ordered following cesarean delivery on inpatient opioid consumption and analgesia. STUDY DESIGN At our tertiary care institution, our standard as-needed opioid order was reduced from oxycodone 5-10mg every 4 h to oxycodone 5mg every 6 h, in May 2019. Orders for scheduled acetaminophen and non-steroidal anti-inflammatory drugs were unchanged. We compared opioid use and pain scores before (February 2019 - April 2019) and after (May 2019 - July 2019) the order modification. Our primary outcome was the proportion of patients using > 30mg of oxycodone in the 24 h prior to hospital discharge. We further assessed 48-h opioid consumption and patient reported verbal pain scores. RESULTS There were 559 patients who met inclusion criteria; 241 pre-intervention patients and 318 post-intervention patients. In the pre-intervention group, 14.5% (35/241) used >30 mg oxycodone in the 24 hours before discharge, compared with 5.0% (16/318) after the order set change (RR 0.34, CI (0.19, 0.61); NNT 10.5). There was no change in the proportion of women with one or more pain score > 7 (Pre: 44.4% (107/241), Post 43.1% (137/318), p=0.756) or > 4 and 7 (pre: 36.9% (89/241), post 36.9% (125/318), p=0.567), nor was there a change in mean pain score (mean SD pre: 2.8 1.6; post: 2.7 1.4, p=0.464). CONCLUSION Reducing the amount of opioid ordered after cesarean delivery reduced the proportion of post-cesarean delivery patients exceeding the maximum recommended daily oxycodone dose for breastfeeding women.
               
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