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Scheduled versus as-needed postpartum analgesia and oxycodone utilization.

Matthew J Blitz1, Burton Rochelson1, Lakha Prasannan1

  • 1Division of Maternal-Fetal Medicine, North Shore University Hospital, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, USA.

The Journal of Maternal-Fetal & Neonatal Medicine : the Official Journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians
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Summary

Scheduled multimodal analgesia, including around-the-clock (ATC) dosing, did not increase oxycodone use in postpartum patients after cesarean delivery. However, it was associated with increased oxycodone initiation after vaginal delivery without altering overall consumption.

Keywords:
Postpartum analgesiamultimodal analgesiaoxycodonepostpartum painscheduled vs. as-needed

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Area of Science:

  • Obstetrics and Gynecology
  • Pain Management
  • Pharmacology

Background:

  • Optimal postpartum analgesia balancing pain relief and opioid misuse risk remains unclear.
  • Limited research compares around-the-clock (ATC) scheduled versus as-needed (PRN) opioid dosing for postpartum pain.
  • Current practices often reserve opioids for breakthrough pain, contrasting with proactive multimodal approaches.

Purpose of the Study:

  • To evaluate the impact of scheduled (ATC) versus PRN dosing of acetaminophen, ibuprofen, and low-dose oxycodone on inpatient oxycodone use.
  • To assess the effect of these analgesic modalities on patient satisfaction with pain control.
  • To compare inpatient oxycodone utilization and patient-reported pain control outcomes before and after implementing a scheduled multimodal analgesia protocol.

Main Methods:

  • Retrospective cohort study of 19,192 deliveries at a tertiary hospital (2013-2016).
  • Implementation of a scheduled multimodal analgesic regimen (including ATC dosing) in month 21, contrasting with prior PRN-only pain relief.
  • Interrupted time series analysis evaluated trends in oxycodone use; Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys compared patient satisfaction.

Main Results:

  • Scheduled multimodal analgesia did not alter oxycodone use percentage or mean consumption per day after cesarean delivery.
  • Following vaginal delivery, scheduled analgesia was associated with an increase in the percentage of patients receiving oxycodone, but not mean consumption.
  • Patient-reported pain control improved significantly after cesarean delivery with the scheduled protocol (71% vs. 63% reporting 'Always' well controlled).

Conclusions:

  • Scheduled multimodal analgesia, including ATC dosing of acetaminophen, ibuprofen, and low-dose oxycodone, is safe and effective for postpartum pain management after cesarean delivery.
  • This approach does not increase overall oxycodone consumption compared to PRN dosing in the postpartum period.
  • While associated with increased initiation of oxycodone after vaginal delivery, scheduled dosing does not elevate mean consumption, suggesting potential benefits for pain management.