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Clinical and Experimental Obstetrics & Gynecology  2021, Vol. 48 Issue (5): 1162-1166    DOI: 10.31083/j.ceog4805186
Original Research Previous articles | Next articles
Multimodal stepwise analgesia for reducing opioid consumption after cesarean delivery
Uros Visic1, Tatjana Stopar Pintaric2, 3, Tit Albreht4, 5, Iva Blajic2, Miha Lucovnik1, 6, *()
1Department of Perinatology, Division of Obstetrics and Gynecology, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
2Department of Anesthesiology and Intensive Therapy, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
3Institute of Anatomy, Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
4National Institute of Public Health, 1000 Ljubljana, Slovenia
5Department of Public Health, Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
6Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
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Abstract  
Background: Opioid over-prescription after cesarean delivery (CD) delays postoperative recovery, interferes with breastfeeding and may prompt persistent opioid use after hospital discharge. We evaluated the effects of implementing a multimodal stepwise analgesic regimen on opioid consumption and pain scores after CD. Methods: This was a retrospective before-after study. Opioid intake (expressed as morphine milligram equivalents (MME)) and pain scores (using the 11-point numerical rating score) within 24-hours following planned cesarean delivery under spinal anesthesia without intrathecal morphine were compared before vs. after change in post-cesarean analgesia regimen. This included intensified non-opioid analgesia with quadratus lumborum block and shifting from scheduled to as-needed opioids. Mann-Whitney U test was used for statistical comparison (p < 0.05 was considered statistically significant). Results: We included 116 women: 58 in pre-intervention and 58 in post-intervention group. There was an 86% reduction in MME (median 14 (interquarile range (IQR) 14–18) mg pre-intervention vs. 2 (IQR 2–4) mg post-intervention; p < 0.001). Pain scores were statistically higher at 2 and 4 hours post-CD in the post-intervention group (1 (IQR 1–2) vs. 2 (IQR 1–3); p = 0.001, and 2 (IQR 1–3) vs. 2 (IQR 2–3); p = 0.03, respectively) but lower at 6 hours post-CD (3 (IQR 2–4) vs. 2 (IQR 2–3); p = 0.02). No statistically significant difference in pain scores at 1, 12 and 24 hours post-CD were observed. Conclusion: Multimodal stepwise analgesic regimen allowed shifting from scheduled to as-needed opioids for post-CD pain management without increase in pain scores. This resulted in significant reduction in opioid consumption after CD.
Key words:  Analgesia      Cesarean delivery      Cesarean section      Opioids      Regional anesthesia     
Submitted:  24 April 2021      Revised:  31 May 2021      Accepted:  09 June 2021      Published:  15 October 2021     
Fund: 
TP 20180063/University Medical Centre Ljubljana, Slovenia
*Corresponding Author(s):  Miha Lucovnik     E-mail:  miha.lucovnik@kclj.si

Cite this article: 

Uros Visic, Tatjana Stopar Pintaric, Tit Albreht, Iva Blajic, Miha Lucovnik. Multimodal stepwise analgesia for reducing opioid consumption after cesarean delivery. Clinical and Experimental Obstetrics & Gynecology, 2021, 48(5): 1162-1166.

URL: 

https://ceog.imrpress.com/EN/10.31083/j.ceog4805186     OR     https://ceog.imrpress.com/EN/Y2021/V48/I5/1162

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