Labor prior to cesarean delivery associated with higher post-discharge opioid consumption

Autor: Sara M. Burns, Brian T. Bateman, Timothy T. Houle, Holly B. Ende, Naida M. Cole, Ruth Landau, Lisa Leffert, Pamela Flood, Melissa E. Bauer, Lawrence C. Tsen, Jessica L. Booth
Rok vydání: 2020
Předmět:
Postpartum depression
Maternal Health
Rate ratio
Epidural Block
Labor and Delivery
0302 clinical medicine
030202 anesthesiology
Pregnancy
Anesthesiology
Medicine and Health Sciences
Anesthesia
Prospective cohort study
Pain
Postoperative
Analgesics
030219 obstetrics & reproductive medicine
Multidisciplinary
Labor
Obstetric
Pharmaceutics
Confounding
Drugs
Obstetrics and Gynecology
Patient Discharge
Analgesics
Opioid
Obstetric Procedures
Medicine
Female
medicine.drug
Tablets
Research Article
Adult
medicine.medical_specialty
Science
Pain
Context (language use)
Surgical and Invasive Medical Procedures
03 medical and health sciences
Signs and Symptoms
Drug Therapy
Internal medicine
medicine
Humans
Pain Management
Medical prescription
Pharmacology
business.industry
Cesarean Section
medicine.disease
Opioids
Opioid
Birth
Women's Health
Local and Regional Anesthesia
Clinical Medicine
Analgesia
business
Complication
Zdroj: PLoS ONE
PLoS ONE, Vol 16, Iss 7, p e0253990 (2021)
ISSN: 1932-6203
Popis: Background Severe acute post-cesarean delivery (CD) pain has been associated with an increased risk for persistent pain and postpartum depression. Identification of women at increased risk for pain can be used to optimize post-cesarean analgesia. The impact of labor prior to CD (intrapartum CD) on acute post-operative pain and opioid use is unclear. We hypothesized that intrapartum CD, which has been associated with both increased inflammation and affective distress related to an unexpected surgical procedure, would result in higher postoperative pain scores and increased opioid intake. Methods This is a secondary analysis of a prospective cohort study examining opioid use up to 2 weeks following CD. Women undergoing CD at six academic medical centers in the United States 9/2014-3/2016 were contacted by phone two weeks following discharge. Participants completed a structured interview that included questions about postoperative pain scores and opioid utilization. They were asked to retrospectively estimate their maximal pain score on an 11-point numeric rating scale at multiple time points, including day of surgery, during hospitalization, immediately after discharge, 1st week, and 2nd week following discharge. Pain scores over time were assessed utilizing a generalized linear mixed-effects model with the patient identifier being a random effect, adjusting for an a priori defined set of confounders. A multivariate negative binomial model was utilized to assess the association between intrapartum CD and opioid utilization after discharge, also adjusting for the same confounders. In the context of non-random prescription distribution, this model was constructed with an offset for the number of tablets dispensed. Results A total of 720 women were enrolled, 392 with and 328 without labor prior to CD. Patients with intrapartum CD were younger, less likely to undergo repeat CD or additional surgical procedures, and more likely to experience a complication of CD. Women with intrapartum CD consumed more opioid tablets following discharge than women without labor (median 20, IQR 10–30 versus 17, IQR 6–30; p = 0.005). This association persisted after adjustment for confounders (incidence rate ratio 1.16, 95% CI 1.05–1.29; p = 0.004). Pain scores on the day of surgery were higher in women with intrapartum CD (difference 0.91, 95% CI 0.52–1.30; adj. p = Conclusion Intrapartum CD is associated with worse pain on the day of surgery but not other time points. Opioid requirements following discharge were modestly increased following intrapartum CD.
Databáze: OpenAIRE
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