Opiate Prescribing Practices in the Postpartum Unit

Louisiana is significantly impacted by the opioid epidemic. In preparation for a quality improvement project aimed at decreasing postpartum narcotics prescriptions, we evaluated routine prescribing practices on a postpartum unit and the number of patient-initiated encounters for postpartum pain.

We conducted a retrospective medical record review of all vaginal deliveries occurring at Ochsner Baptist Medical Center in New Orleans, LA in December 2016 and January 2017. We collected patient demographics, inpatient and outpatient pain medications, and the number of postpartum pain-related encounters prior to the scheduled postpartum visit. We evaluated the cohort for inpatient medication usage and for postpartum encounters for pain.

After exclusions, 187 of 369 patients were included in the analysis: 78 patients had no perineal laceration, 40 had a first-degree laceration, and 69 had a second-degree laceration. The no-laceration (P=0.007) and second-degree laceration (P=0.011) groups had a significantly higher mean morphine milligram equivalent (MME) per patient during hospitalization than the first-degree group. Sixty-four patients were primiparous, and 123 were multiparous. Parity decreased as the severity of the laceration increased. Multiparous patients had a higher mean MME than primiparous patients (34.5 vs 30.0, respectively) during hospitalization, but the difference was not significant. In the no-laceration group, multiparous patients used significantly more narcotics during hospitalization (mean 41.4 MME) than primiparous patients (mean 22.5 MME) (P=0.029). A total of 3,635 narcotic pills were prescribed for our cohort at discharge, an average of 19.4 pills per patient. Overall, the mean number of postpartum encounters for pain was 0.19 per patient, with no difference between groups.

Despite a high number of outpatient narcotics prescriptions, approximately 1 in 5 patients initiated an encounter to address pain after vaginal delivery. Parity may play a role in postpartum inpatient narcotic usage, possibly because multiparous patients have had prior exposure to narcotics use in postpartum care.