Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Opioid Prescribing After Cesarean Delivery

Obstet Gynecol; ePub 2018 Aug 4; Prabhu, et al

Implementation of a multiphase quality improvement protocol to decrease opioid prescribing resulted in a significant decrease in the number of opioid tablets prescribed after cesarean delivery, a recent study found. In phase 1 of the protocol, discharge providers implemented counseling regarding expectations for pain, typical need for opioids, and importance of multimodal nonopioid analgesic use and used shared decision-making to determine the number of opioids prescribed. In phase 2, researchers adjusted the protocol’s maximum opioid prescription to 25 opioid tablets, but no other aspects of the protocol were changed. They found:

  • Data from 624 women who underwent cesarean deliveries were analyzed.
  • Opioids were prescribed after 95% of all cesarean deliveries (most commonly oxycodone).
  • The mean (SD) number of opioid tablets prescribed decreased from 33.2 to 26.5 with the implementation of phase 1 having no effect on the opioid refill rate, 8.9% vs 8.1%.
  • These results allowed adjustment of the maximum recommended prescription to 25 opioid tablets, during which the mean (SD) number of opioid tablets prescribed further decreased from 24.9 to 21.5.
  • Overall, this represents a 35% decrease in opioid prescribing.

Citation:

Prabhu M, Dubois H, James K, et al. Implementation of a quality improvement initiative to decrease opioid prescribing after cesarean delivery. [Published online ahead of print August 4, 2018]. Obstet Gynecol. doi:10.1097/AOG.0000000000002789.

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Prophylactic Antibiotic Use in Labor & Delivery, Obstet Gynecol; 2018 Sep; Coleman, et al

USPSTF on Screening for Cervical Cancer, JAMA; 2018 Aug 21; US Preventive Services Task Force

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Must Reads in Obstetrics

Prophylactic Antibiotic Use in Labor & Delivery, Obstet Gynecol; 2018 Sep; Coleman, et al

Prevention of Obstetric Lacerations at Vaginal Delivery, Obstet Gynecol; 2018 Sep; Cichowski, et al

Opioid Prescribing After Cesarean Delivery, Obstet Gynecol; ePub 2018 Aug 4; Prabhu, et al

Sexual Orientation & Risk of Violence in Abortion, Obstet Gynecol; ePub 2018 Aug 6; Jones, et al

Opioid Dispensing After Vaginal Delivery, Obstet Gynecol; ePub 2018 Jul 10; Prabhu, et al