Opioid-free multimodal analgesia pathway to decrease opioid utilization after cesarean delivery

Area of Science:

• Obstetrics and Gynecology
• Anesthesiology
• Pain Management

Background:

• Cesarean delivery (CD) often requires effective pain management to ensure patient recovery.
• Opioid utilization post-CD can lead to dependence and adverse effects.
• Multimodal analgesic pathways (MAP) offer a promising alternative to traditional opioid-based pain control.

Purpose of the Study:

• To evaluate an opioid-free multimodal analgesic pathway (MAP) for pain management after cesarean delivery (CD).
• To compare opioid utilization in patients receiving MAP versus historical data (pre-MAP).
• To assess patient satisfaction with pain control under the MAP protocol.

Main Methods:

• Implementation of a phased MAP from September 2018 to August 2019.
• Intravenous (IV) acetaminophen and ketorolac administered at set intervals post-CD.
• Oral ibuprofen and acetaminophen used for pain management based on Numeric Pain Intensity Scale scores.
• Oral oxycodone reserved for rescue analgesia; patients discharged without opioid prescriptions.

Main Results:

• Significant reduction in inpatient opioid consumption from 45% to 23.8% (P<0.001).
• Significant reduction in outpatient opioid consumption from 18% to 8.5% (P<0.001).
• Over 90% of patients reported well-controlled pain and willingness to use the regimen again.

Conclusions:

• MAP implementation effectively decreased both inpatient and outpatient opioid consumption post-CD.
• The opioid-free MAP maintained high levels of patient satisfaction with pain management.
• This pathway represents a successful strategy for opioid-sparing pain control after cesarean delivery.