Multimodal Pain Management for Cesarean Delivery: A Double-Blinded, Placebo-Controlled, Randomized Clinical Trial
| Autor: | Yara Ramirez, Maged M. Costantine, Michelle Simon, Giuseppe Chiossi, Lucia Pacheco, George R. Saade, Viviana Ellis, Rovnat Babazade, Luis Monsivais, Emily E. Hadley |
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| Rok vydání: | 2019 |
| Předmět: |
Adult
Injections Subcutaneous Placebo Injections Intramuscular Perioperative Care law.invention 03 medical and health sciences 0302 clinical medicine Randomized controlled trial Double-Blind Method law Pregnancy Elective Cesarean Delivery medicine Animals Humans Pain Management Anesthetics Local Acetaminophen Bupivacaine Pain Postoperative 030219 obstetrics & reproductive medicine business.industry Cesarean Section Obstetrics and Gynecology Perioperative Analgesics Non-Narcotic Ketorolac Analgesics Opioid Regimen Opioid Anesthesia Pediatrics Perinatology and Child Health Injections Intravenous Analgesia Obstetrical Drug Therapy Combination Female business medicine.drug |
| Zdroj: | American journal of perinatology. 36(11) |
| ISSN: | 1098-8785 |
| Popis: | Objective Our objective was to evaluate the efficacy of perioperative multimodal pain management in reducing opioid use after elective cesarean delivery (CD). Study Design A single-center, double-blinded, placebo-controlled randomized trial of women undergoing elective CD. Participants were allocated 1:1 to receive the multimodal protocol or matching placebos. The multimodal protocol consisted of a preoperative dose of intravenous acetaminophen, preincision injection of subcutaneous bupivacaine, and intraoperative injection of intramuscular ketorolac. Primary outcome was total opioid intake at 48 hours postoperatively. Secondary outcomes were pain scores, time to first opioid intake, neonatal outcomes, and total outpatient opioid intake on postoperative day (POD) 7. Data were analyzed using parametric and nonparametric tests and quantile regression as appropriate. Results A total of 242 women were screened with 120 randomized, 60 to the multimodal group and 60 to control group. There was no significant difference in the primary outcome of opioid use nor in the secondary outcomes. Smokers and patients with a history of drug use had higher median postoperative opiate use and earlier administration. On POD 7, only 40% of prescribed opioids had been used, and there was no difference between the groups. Conclusion This perioperative multimodal pain regimen did not reduce opioid use in 48 hours after CD. Patients who smoke or with a history of drug use required more opioids in the postoperative period. Providers significantly overprescribed opioids after CD. |
| Databáze: | OpenAIRE |
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