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ASA: Unnecessary Opioids Often Prescribed After C-Section

Change in computerized order sets reduces use of oxycodone to treat pain after cesarean delivery

MONDAY, Oct. 21, 2019 (HealthDay News) — Opioids are commonly not needed but are overprescribed at discharge among women who undergo cesarean deliveries (CDs), and provider education and new order sets can reduce use of oxycodone for post-CD pain management, according to two studies presented at the annual meeting of the American Society of Anesthesiologists, held from Oct. 19 to 23 in Orlando, Florida.

Ben Shatil, D.O., from the Columbia University Medical Center in New York City, and colleagues examined the impact of a two-step intervention (i.e., education for all obstetrics providers and computerized order sets for post-CD pain management) to reduce consumption of oxycodone following CD. The researchers found that adherence to the new orders (ibuprofen and acetaminophen every six hours regardless of pain scores with oxycodone given only for moderate to severe pain) was 82.8 percent. Following the intervention, there was a threefold increase in the number of women not taking any oxycodone after CD (9.6 to 29.8 percent) and an almost threefold decrease in cumulative oxycodone dose (60 to 25 mg).

In a second study, also at Columbia University Medical Center, Ruthi Landau Cahana, M.D., and colleagues used an institutional quality dashboard to identify all CD cases in 2018. Patterns of opioid use were examined following the implementation in 2017 of new initiatives promoting opioid-sparing analgesia after CD. The researchers found that 89 percent received an opioid prescription at discharge, including women who took no opioids after their CD. Opioid prescriptions at discharge were slightly higher for women who took no opioids in the previous 24 hours (91.8 percent), with estimated overprescription occurring in 49.9 percent of the entire cohort.

“With a robust intervention targeting the reduction of hospital opioid consumption, we were able to achieve spectacular results, but more steps are needed at the tail end of the patient’s hospital stay to further reduce opioid consumption and prescription patterns,” Landau Cahana said in a statement. “We are working to further educate prescribers to tailor prescriptions at discharge.”

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