(729) An updated rapid review of pain management following cesarean birth

Friday, January 31, 2025

10:30 AM – 12:30 PM

Submitting Author and Presenting Author(s)

Dana Feldman, MD (she/her/hers)

Resident
Wake Forest University
Winston-Salem, NC, United States

Coauthor(s)

Bryan L. Aaron, MD (he/him/his)

Medical Student
University of Michigan
Ann Arbor, Michigan, United States
FG

Faith Gacheru, N/A

University of Michigan
Ann Arbor, Michigan, United States
HS

Holli Sharples, BS

University of Michigan
Ann Arbor, Michigan, United States
Michelle Moniz, MD, MSc (she/her/hers)

Associate Professor
University of Michigan
Ann Arbor, Michigan, United States
JW

Jennifer Waljee, MD

University of Michigan
Ann Arbor, Michigan, United States
MB

Mark Bicket, MD, PhD

University of Michigan
Ann Arbor, Michigan, United States
Lisa Kane Low, CNM, PhD (she/her/hers)

University of Michigan
Ann Arbor, Michigan, United States
LJ

LaTeesa James, MA

Health Sciences Informationist
University of Michigan
Ann Arbor, Michigan, United States
Alex Peahl, MD, MSc (she/her/hers)

Michigan Medicine
Ann Arbor, Michigan, United States

Objective: To update our rapid review assessing the evidence for key aspects of pain management following cesarean birth, to inform new clinical practice guidelines.

Study Design: We used Ovid MEDLINE, Elsevier's Scopus, Elsevier’s Embase, Google Scholar, PubMed, and Web of Science to perform a narrative synthesis of studies that assessed opioid use, analgesia effects, patient-centered outcomes, and disparities in the general population, patients with opioid use disorder (OUD), chronic pain, and psychiatric conditions. Articles were screened and abstracted by two reviewers. Quality was assessed using the RAND/UCLA Appropriateness Methodology approach.

Results: Of 2753 studies screened, 106 were included: 24 RCTs, 5 non-RCTs, and 77 observational studies (7 with very high/critical, 28 with high/serious, 25 with moderate/some concerns for, and 17 with low risk of bias). Following cesarean birth, multimodal, non-opioid interventions (e.g. scheduled ibuprofen and acetaminophen) consistently reduced opioid consumption and/or prescribing without increasing pain. discharge prescribing studies showed variability and racial/ethnic disparities following cesarean births. Patients with chronic pain and psychiatric conditions had increased opioid exposure and persistent use. Non-pharmacologic strategies had limited evidence for pain reduction but high satisfaction. Tailored prescribing reduced outpatient opioid use without worsening pain control. Higher inpatient use, discharge prescription size, and substance abuse history were associated with new persistent opioid use. Patients with chronic pain and psychiatric conditions had increased opioid exposure and persistent use.

Conclusion: Multimodal opioid-sparing strategies provide adequate pain control while limiting opioid use after cesarean birth. Non-pharmacologic methods may provide low-risk enhancement in pain management. There are significant evidence gaps for postpartum pain management in patients with OUD, chronic pain, and psychiatric conditions.