(311) Perioperative Pain Management and Opioid Prescribing: Impact of Obstetric Enhanced Recovery After Surgery Protocol Implementation

We conducted a retrospective cohort study of pregnant women undergoing cesarean delivery between April 2020 to April 2022 – 1 year before and after implementation of an institutional obstetric ERAS protocol. Data regarding demographic characteristics, pregnancy comorbidities (chronic hypertension, hypertensive disorders of pregnancy, pregestational/gestational diabetes, and tobacco use), as well as improvement science-based process and outcome measures related to narcotic administration, postoperative pain scores, multimodal analgesia, and opioid prescribing at hospital discharge were extracted from electronic records and compared across 2 groups - pre- and post-ERAS implementation. Student t-test, Pearson’s Chi-square, Mann-Whitney U, and/or Fisher’s exact test were used as indicated. Statistical significance was set at p≤ .05.

Results:

Demographic characteristics and pregnancy comorbidities were similar across pre (n=494) and post (n=432) ERAS implementation groups. Patients in the post-ERAS group had significantly higher pain scores at 6 (p< .001) and 12 hours (p< .001) but significantly lower scores at 48 hours (p=.035) postoperatively. Postoperative acetaminophen use was higher (p< .001) in the post-ERAS group with no significant differences in the overall postoperative narcotic use, number of narcotic doses needed and morphine milliequivalents (MME) on postoperative day 2, across both groups. While a similar proportion of patients in each group received narcotic prescriptions at discharge, patients in the post-ERAS group were prescribed fewer number of narcotic pills (p< .001) and lesser MME overall (p< .001) at hospital discharge.

Conclusion: Implementation of an obstetric ERAS protocol has the potential to facilitate more judicious postpartum opioid prescribing at hospital discharge without compromising postoperative pain control.