Optimizing Opioid Prescription Quantity After Cesarean Delivery: A Randomized Controlled Trial

Area of Science:

• Obstetrics and Gynecology
• Pain Management
• Pharmacology

Background:

• Postcesarean pain management often involves fixed quantities of opioid analgesics.
• There is a need for personalized approaches to optimize pain relief and reduce opioid exposure.
• Shared decision-making (SDM) holds potential for tailoring treatment plans.

Purpose of the Study:

• To evaluate if an individualized opioid-prescription protocol (IOPP) with SDM is non-inferior to a fixed quantity of opioids for postcesarean pain.
• To assess the impact of IOPP with SDM on opioid tablet utilization after cesarean delivery.

Main Methods:

• A multicenter, randomized controlled noninferiority trial comparing IOPP with SDM to a fixed quantity (20 tablets) of oxycodone.
• Participants (n=5,521) with uncomplicated cesarean births were randomized 1:1.
• The primary outcome was moderate to severe pain (BPI score ≥4) at 1 week postdischarge.

Main Results:

• IOPP with SDM was non-inferior to the fixed quantity for pain management at 1 week postdischarge (59.5% vs 60.1%).
• The IOPP group received significantly fewer opioid tablets (median 14 vs 20) through 90 days postpartum (P <.001).
• No compromise in postcesarean pain management was observed with the individualized protocol.

Conclusions:

• Individualized opioid-prescription protocol with shared decision-making is a safe and effective strategy for postcesarean analgesia.
• This approach leads to reduced opioid prescribing without negatively impacting pain control.
• SDM in opioid prescribing can optimize patient care and potentially mitigate risks associated with opioid use.