Tailoring prescriptions individually to a patient’s needs after cesarean delivery can decrease opioid use while successfully managing post-surgical pain, according to a new study by researchers at UT Southwestern Medical Center. The change in protocol, detailed in a study published in the American Journal of Obstetrics & Gynecology, lessened the number of opioids released into the North Texas community by more than 90,000 tablets per year.
“Decreasing the flow of opioids into our community is imperative, both to prevent new opioid dependence in women undergoing cesarean delivery as well as ensuring pills are not diverted to others,” said lead author Elaine Duryea, M.D., Associate Professor of Obstetrics and Gynecology at UT Southwestern and Chief of Obstetrics at Parkland Health.
Dr. Duryea and her colleagues compared pain management strategies between two groups of patients who had cesarean deliveries at Parkland Memorial Hospital, the public safety net hospital in Dallas. While both groups were given opioids in the hospital, patients in one group received a standard prescription of 30 tablets of acetaminophen-codeine 300/30 mg and instructions to take ibuprofen as needed after they were discharged. Women in the second group were prescribed amounts of oxycodone tablets equal to five times the amount of their opioid use in the 24 hours before discharge along with nonsteroidal anti-inflammatory drugs (NSAIDs). Women in this second group, whose babies were delivered after the implementation of this personalized prescribing protocol, also had access to a hotline to discuss any pain control issues.
Despite a considerable reduction in prescribed opioids, the personalized prescription protocol succeeded in helping patients manage post-surgical pain. About 43% of patients in the second group did not need any opioids in the 24 hours before their hospital discharge, so they were not prescribed any opioids. Only 2% of patients used the hotline, and none required reevaluation; they were able to manage their pain with over-the-counter medications.
“Limiting the amount of opioids prescribed in the postpartum period is critical,” said first author Chinonye Imo, M.D., a Resident Physician in Obstetrics and Gynecology at UT Southwestern, “but even more critical is individualizing how opioids are prescribed to ensure adequate pain control for patients at home.”
The researchers believe this personalized approach to prescriptions, which they continue to use after cesarean deliveries at Parkland, can easily translate across different medical specialties and locations. “If implemented at a national level, the reduction in opioids released into our community would be meaningful,” Dr. Duryea said.
This project was supported, in part, by funding from the Parkland Community Health Plan, a component unit of Dallas County Hospital District, doing business as Parkland Health.
Other UTSW researchers who contributed to this study were Donald D. McIntire, Ph.D., Professor of Obstetrics and Gynecology, and David B. Nelson, M.D., Associate Professor of Obstetrics and Gynecology and Chief of the Division of Maternal-Fetal Medicine. Devin A. Macias, M.D., a former fellow in Maternal-Fetal Medicine at UTSW, is now a specialist of obstetrics and gynecology at Perinatal Associates of Sacramento. Dr. Nelson holds the Gillette Professorship of Obstetrics and Gynecology and is a Dedman Family Scholar in Clinical Care. (MV/Newswise)
