Decreasing opioid provision and use while maintaining analgesia efficacy in cervical preparation with osmotic...

To reduce opioid use and provision while maintaining analgesia and patient satisfaction with osmotic dilators for cervical preparation before dilation and evacuation (D&E).

We conducted a quality improvement initiative to reduce opioid use by studying an analgesia protocol change from the existing "routine opioid provision" to a novel "opioid-sparing" protocol. We collected data through patient surveys from patients undergoing overnight osmotic dilators before D&E from 16 to 26 weeks of gestation. We assessed pain on a numeric rating scale (0-10) before dilator placement (baseline) and D&E. The primary outcome was median change in individual pain score from baseline to maximum overnight with osmotic dilators in place.

Opioid provision (93.9% vs 10.3%, p < 0.001) and opioid use (57.6% vs 7.7%, p < 0.001) were lower in the novel opioid-sparing group. Median change in individual pain score was lower in the novel opioid-sparing group (7.0 [0-10]) compared to the existing routine opioid group (8.0 [0-10]) (p = 0.01).

The novel opioid-sparing protocol reduced opioid provision and use while also demonstrating lower pain scores and maintaining satisfaction in patients undergoing osmotic dilators before D&E.

Limiting opioid use for cervical preparation with osmotic dilators before second-trimester dilation and evacuation can reduce opioid provision and use, while maintaining analgesia efficacy and patient satisfaction.