Opioid consumption and pain scores following perineal lacerations: a retrospective cohort study (2019-2023)

Perineal lacerations frequently complicate vaginal deliveries and impact recovery.

We examined the relationship between laceration severity and opioid consumption with scheduled multimodal analgesia through a retrospective cohort study (2019-2023) of 14,477 vaginal deliveries. Propensity score matching was used to address baseline group imbalances, followed by logistic regression analysis.

Distribution included: no lacerations (26.9%), first- or second-degree (69.0%), and third- or fourth-degree (4.0%). Patients with third- or fourth-degree lacerations more frequently consumed opioids (19.4%) compared to those with no lacerations (10.4%) or first- or second-degree lacerations (7.5%) (P < 0.001). After propensity score matching and multivariable adjustment, third- or fourth-degree lacerations carried 3.98 times higher odds of opioid use compared to no lacerations (95% CI 3.26-4.87, P < 0.001), while patients with first- or second-degree lacerations were significantly less likely to use opioids (OR 0.33, 95% CI 0.26-0.44, P < 0.001). Opioid doses were significantly higher for third- or fourth-degree lacerations at 24-48 h (15 mg vs. 7.5 mg morphine equivalents, P = 0.009). These patients also reported consistently higher pain scores throughout the first 72 h.

Despite scheduled multimodal analgesia, third- and fourth-degree perineal lacerations are associated with significantly higher opioid consumption and pain scores, suggesting the need for enhanced management strategies and closer monitoring.