| Author/Editor | Višić, Uroš; Stopar Pintarič, Tatjana; Albreht, Tit; Blajić, Iva; Lučovnik, Miha | |
| Title | Multimodal stepwise analgesia for reducing opioid consumption after cesarean delivery | |
| Type | članek | |
| Vol. and No. | Letnik 48, št. 5 | |
| Publication year | 2021 | |
| Volume | str. 1162-1166 | |
| ISSN | 0390-6663 - Clinical and experimental obstetrics & gynecology | |
| Language | eng | |
| Abstract | Background: Opioid over-prescription after cesarean delivery (CD) delays postoperative recovery, interferes with breastfeeding and may prompt persistent opioid use after hospital discharge. We evaluated the effects of implementing a multimodal stepwise analgesic regimen on opioid consumption and pain scores after CD. Methods: This was a retrospective before-after study. Opioid intake (expressed as morphine milligram equivalents (MME)) and pain scores (using the 11-point numerical rating score) within 24-hours following planned cesarean delivery under spinal anesthesia without intrathecal morphine were compared before vs. after change in post-cesarean analgesia regimen. This included intensified non-opioid analgesia with quadratus lumborum block and shifting from scheduled to as-needed opioids. Mann-Whitney U test was used for statistical comparison (p < 0.05 was considered statistically significant). Results: We included 116 women: 58 in pre-intervention and 58 in post-intervention group. There was an 86% reduction in MME (median 14 (interquarile range (IQR) 14-18) mg pre-intervention vs. 2 (IQR 2-4) mg post-intervention; p < 0.001). Pain scores were statistically higher at 2 and 4 hours post-CD in the post-intervention group (1 (IQR 1-2) vs. 2 (IQR 1-3); p = 0.001, and 2 (IQR 1-3) vs. 2 (IQR 2-3); p = 0.03, respectively) but lower at 6 hours post-CD (3 (IQR 2-4) vs. 2 (IQR 2-3); p = 0.02). No statistically significant difference in pain scores at 1, 12 and 24 hours post-CD were observed. Conclusion: Multimodal stepwise analgesic regimen allowed shifting from scheduled to as-needed opioids for post-CD pain management without increase in pain scores. This resulted in significant reduction in opioid consumption after CD. | |
| Keywords | analgesia cesarean delivery regional anesthesia analgezija carski rez regionalna anestezija |