Poster Session 1
Ruth Landau, MD (she/her/hers)
Virginia Apgar Professor of Anesthesiology
Columbia University
New York, NY, United States
Uma M. Reddy, MD, MPH (she/her/hers)
Professor and Vice Chair of Research, Department of Obstetrics and Gynecology
Columbia University
New York, New York, United States
Improving pain trajectories after cesarean delivery (CD) with minimal to no opioid use is a challenging goal: opioid reduction may result in uncontrolled pain, yet in-hospital opioid use may be associated with persistent opioid use after discharge. Our objective was to evaluate factors associated with opioid use after CD, with 2 aims: characterize patients with no in-hospital opioid use after CD, and identify pre/peri-delivery factors associated with no opioid use.
Study Design:
Secondary analysis of a controlled trial in patients who underwent CD at 31 U.S. hospitals (2020-22) and were randomized to individualized or fixed quantity of opioid tablets at discharge. For this analysis, participants were categorized into one of 2 groups based on opioid use (morphine milligram equivalents [MME]), with MME=0 indicating no in-hospital opioid use. Secondary outcomes were worst pain on the (Brief Pain Inventory [BPI] score) and Pain Catastrophizing Score (PCS) assessed within 24 hours of discharge. Univariable and multivariable logistic regression analyses with backward selection were performed to identify factors associated with no in-hospital opioid use.
Results: Of 5515 eligible participants, 1023 (19%) had MME=0. On multivariable analysis, Black race, government insurance, anxiety/depression, and preterm birth were associated with decreased odds for MME=0 (Table 1). In contrast, Hispanic ethnicity, spinal or combined spinal-epidural (CSE) anesthesia, and neuraxial morphine administration were associated with increased odds for MME=0. Participants with BPI ³ 4 or PCS ≥ 13 were more likely to use opioids (Table 2).
Conclusion:
Patient-specific factors, including anxiety/depression and preterm birth were associated with increased in-hospital opioid use after CD, while anesthesia technique (spinal and CSE) and neuraxial morphine administration were associated with reduced opioid use. No opioid use was not associated with higher in-hospital pain scores or pain catastrophizing.
