Anesthesiology, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA.
Anesthesiology, Montefiore Medical Center, Bronx, New York, USA.
Reg Anesth Pain Med. 2021 Feb;46(2):151-156. doi: 10.1136/rapm-2020-102007. Epub 2020 Nov 10.
Opioid exposure during hospitalization for cesarean delivery increases the risk of new persistent opioid use. We studied the effectiveness of stepwise multimodal opioid-sparing analgesia in reducing oxycodone use during cesarean delivery hospitalization and prescriptions at discharge.
This retrospective cohort study analyzed electronic health records of consecutive cesarean delivery cases in four academic hospitals in a large metropolitan area, before and after implementation of a stepwise multimodal opioid-sparing analgesic computerized order set coupled with provider education. The primary outcome was the proportion of women not using any oxycodone during in-hospital stay ('non-oxycodone user'). In-hospital secondary outcomes were: (1) total in-hospital oxycodone dose among users, and (2) time to first oxycodone pill. Discharge secondary outcomes were: (1) proportion of oxycodone-free discharge prescription, and (2) number of oxycodone pills prescribed.
The intervention was associated with a significant increase in the proportion of non-oxycodone users from 15% to 32% (17% difference; 95% CI 10 to 25), a decrease in total in-hospital oxycodone dose among users, and no change in the time to first oxycodone dose. The adjusted OR for being a non-oxycodone user associated with the intervention was 2.67 (95% CI 2.12 to 3.50). With the intervention, the proportion of oxycodone-free discharge prescription increased from 4.4% to 8.5% (4.1% difference; 95% CI 2.5 to 5.6) and the number of prescribed oxycodone pills decreased from 30 to 18 (-12 pills difference; 95% CI -11 to -13).
Multimodal stepwise analgesia after cesarean delivery increases the proportion of oxycodone-free women during in-hospital stay and at discharge.
剖宫产住院期间使用阿片类药物会增加新的持续性阿片类药物使用的风险。我们研究了逐步多模式阿片类药物节约镇痛在减少剖宫产住院期间羟考酮使用和出院时处方的有效性。
这项回顾性队列研究分析了在一个大城市的四个学术医院中连续进行的剖宫产病例的电子健康记录，在实施逐步多模式阿片类药物节约镇痛计算机医嘱单与提供者教育之前和之后。主要结果是住院期间不使用任何羟考酮的女性比例（“非羟考酮使用者”）。住院期间的次要结果是：（1）使用者的总住院羟考酮剂量，和（2）首次羟考酮片的时间。出院时的次要结果是：（1）无羟考酮出院处方的比例，和（2）羟考酮片的数量。
干预措施与非羟考酮使用者的比例从 15%增加到 32%（17%的差异；95%CI 10 至 25）显著相关，使用者的总住院羟考酮剂量减少，首次羟考酮剂量时间无变化。与干预措施相关的非羟考酮使用者的调整比值比为 2.67（95%CI 2.12 至 3.50）。干预后，无羟考酮出院处方的比例从 4.4%增加到 8.5%（4.1%的差异；95%CI 2.5 至 5.6），处方的羟考酮片数量从 30 片减少到 18 片（-12 片差异；95%CI -11 至 -13）。
剖宫产术后多模式逐步镇痛可增加住院期间和出院时无羟考酮女性的比例。
