Department of Obstetrics and Gynecology, Maternal and Child Health Research Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia.
Am J Perinatol. 2021 Nov;38(13):1341-1347. doi: 10.1055/s-0041-1732378. Epub 2021 Jul 19.
This study was aimed to evaluate opioid use after cesarean delivery (CD) and to assess implementation of an enhanced recovery after CD (ERAS-CD) pathway and its association with inpatient and postdischarge pain control and opioid use.
We conducted a baseline survey of women who underwent CD from January to March 2017 at a single, urban academic hospital. Patients were called 5 to 8 days after discharge and asked about their pain and postdischarge opioid use. An ERAS-CD pathway was implemented as a quality improvement initiative, including use of nonopioid analgesia and standardization of opioid discharge prescriptions to ≤25 tablets of oxycodone of 5 mg. From November to January 2019, a postimplementation survey was conducted to assess the association between this initiative and patients' pain control and postoperative opioid use, both inpatient and postdischarge.
Data were obtained from 152 women preimplementation (PRE) and 137 women post-implementation (POST); complete survey data were obtained from 102 women PRE and 98 women POST. The median inpatient morphine milligram equivalents consumed per patient decreased significantly from 141 [range: 90-195] PRE to 114 [range: 45-168] POST ( = 0.002). On a 0- to 10-point scale, median patient-reported pain scores at discharge decreased significantly (PRE: 7 [range: 5-8] vs. POST 5 [range: 3-7], < 0.001). The median number of pills consumed after discharge also decreased significantly (PRE: 25 [range: 16-30] vs. POST 17.5 [range: 4-25], = 0.001). The number of pills consumed was significantly associated with number prescribed ( < 0.001). The median number of leftover pills and number of refills did not significantly differ between groups. Median patient-reported pain scores at the week after discharge were lower in the POST group (PRE: 4 [range: 2-6] vs. POST 3[range: 1-5], = 0.03).
Implementing an ERAS-CD pathway was associated with a significant decrease in inpatient and postdischarge opioid consumption while improving pain control. Our data suggest that even fewer pills could be prescribed for some patients.
· An ERAS-CD pathway was associated with decreased opioid use.. · Outpatient opioid consumption after cesarean warrants further study.. · Physician prescribing drives patients' opioid consumption..
本研究旨在评估剖宫产术后（CD）的阿片类药物使用情况，并评估强化 CD 后康复（ERAS-CD）路径的实施情况及其与住院和出院后疼痛控制和阿片类药物使用的关系。
我们对 2017 年 1 月至 3 月在一家单家城市学术医院接受 CD 的女性进行了基线调查。患者在出院后 5 至 8 天被呼叫，并询问他们的疼痛和出院后阿片类药物使用情况。ERAS-CD 路径作为一项质量改进举措实施，包括使用非阿片类镇痛药和标准化阿片类药物出院处方，将羟考酮 5mg 片的用量限制在 25 片以内。2019 年 11 月至 1 月，进行了实施后调查，以评估这一举措与患者疼痛控制和术后阿片类药物使用（住院和出院后）之间的关系。
实施前（PRE）获得了 152 名女性的数据，实施后（POST）获得了 137 名女性的数据；实施前获得了 102 名女性的完整调查数据，实施后获得了 98 名女性的完整调查数据。每名患者住院期间消耗的吗啡毫克当量中位数从 141 [范围：90-195] PRE 显著下降到 114 [范围：45-168] POST（ = 0.002）。在 0 到 10 分的范围内，出院时患者报告的疼痛评分中位数显著下降（PRE：7 [范围：5-8] vs. POST 5 [范围：3-7]， < 0.001）。出院后消耗的药丸数量中位数也显著下降（PRE：25 [范围：16-30] vs. POST 17.5 [范围：4-25]， = 0.001）。消耗的药丸数量与开出的药丸数量显著相关（ < 0.001）。两组之间剩余药丸数量和补药数量中位数无显著差异。出院后一周时，POST 组患者报告的疼痛评分中位数较低（PRE：4 [范围：2-6] vs. POST 3[范围：1-5]， = 0.03）。
实施 ERAS-CD 路径与住院和出院后阿片类药物消耗的显著减少相关，同时改善了疼痛控制。我们的数据表明，对于一些患者，甚至可以开出更少的药丸。
· ERAS-CD 路径与阿片类药物使用减少有关。· 剖宫产术后门诊阿片类药物使用情况值得进一步研究。· 医生的处方决定了患者的阿片类药物使用情况。
