Impact of an enhanced recovery program for cesarean delivery on postoperative opioid use

•Cesarean delivery patients in the enhanced recovery program received fewer opioids.•Average pain scores remained mild despite the reduced opioid consumption.•Fewer than half the patients required an opioid within 24 h of discharge.•Early oral intake was not associated with increased anti-emetic req...

Ausführliche Beschreibung

Gespeichert in:
Bibliographische Detailangaben
Veröffentlicht in:International journal of obstetric anesthesia 2020-08, Vol.43, p.47-55
Hauptverfasser: Lester, S.A., Kim, B., Tubinis, M.D., Morgan, C.J., Powell, M.F.
Format: Artikel
Sprache:eng
Schlagworte:
Online-Zugang:Volltext
Tags: Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
container_end_page 55
container_issue
container_start_page 47
container_title International journal of obstetric anesthesia
container_volume 43
creator Lester, S.A.
Kim, B.
Tubinis, M.D.
Morgan, C.J.
Powell, M.F.
description •Cesarean delivery patients in the enhanced recovery program received fewer opioids.•Average pain scores remained mild despite the reduced opioid consumption.•Fewer than half the patients required an opioid within 24 h of discharge.•Early oral intake was not associated with increased anti-emetic requirements. Cesarean delivery is one of the most common surgeries performed worldwide and the adoption of enhanced recovery programs for cesarean delivery is gaining popularity. We tested the hypothesis that implementation of an enhanced recovery program for cesarean delivery would be associated with a decrease in postoperative opioid consumption. We compared a retrospective cohort of women delivered by elective cesarean delivery (January 1, 2017 to June 30, 2018) to a prospective cohort exposed to the enhanced recovery protocol (July 1, 2018 to December 31, 2018). The primary outcome was inpatient maternal opioid use, measured as total oral morphine equivalents. Secondary outcomes included postoperative 0–10 pain scores, length of stay, 30-day postoperative complication rates, and hospital re-admissions. Data from 541 patients were analyzed. The enhanced recovery cohort used significantly less oral morphine equivalents compared with the pre-enhanced recovery cohort (60.3 mg vs 104.3 mg, P 
doi_str_mv 10.1016/j.ijoa.2020.01.005
format Article
fullrecord <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmed_primary_32044216</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S0959289X20300224</els_id><sourcerecordid>2353583005</sourcerecordid><originalsourceid>FETCH-LOGICAL-c422t-a7adb80334c3b7a4e50e370e9e9bfa95b5679bd4b5df4ef95cc7f32b14dd55123</originalsourceid><addsrcrecordid>eNqNkU1rFTEUhoMo9lr9Ay4kS0FmzOedCbiRi9ZCoZsWugv5ONFc7kzGZKbSf9_czrVLcZVD8ryHk-cg9J6SlhK6_bxv4z6ZlhFGWkJbQuQLtKGSs4bzTrxEG6Kkaliv7s7Qm1L2hBDF--1rdMYZEYLR7QbdXQ6TcTNOAZsRw_jLjA48zuDSPeQHPOX0M5sBh5Sxg2IyVMzDIT69phFPqcxpgmzmeoXTFFP0eCnwFr0K5lDg3ek8R7ffv93sfjRX1xeXu69XjROMzY3pjLc94Vw4bjsjQBLgHQEFygajpJXbTlkvrPRBQFDSuS5wZqnwXkrK-Dn6uPatk_5eoMx6iMXB4WBGSEvRjEsue17lVJStqMuplAxBTzkOJj9oSvTRqN7ro1F9NKoJ1Wvow6n_Ygfwz5G_CivQr8AfsCkUF6EafMaqcykUl4zWivJdnKuoNO7SMs41-un_o5X-stJQdd5HyPqU8LGua9Y-xX995BFEFqlB</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2353583005</pqid></control><display><type>article</type><title>Impact of an enhanced recovery program for cesarean delivery on postoperative opioid use</title><source>Web of Science - Science Citation Index Expanded - 2020&lt;img src="https://exlibris-pub.s3.amazonaws.com/fromwos-v2.jpg" /&gt;</source><source>Access via ScienceDirect (Elsevier)</source><creator>Lester, S.A. ; Kim, B. ; Tubinis, M.D. ; Morgan, C.J. ; Powell, M.F.</creator><creatorcontrib>Lester, S.A. ; Kim, B. ; Tubinis, M.D. ; Morgan, C.J. ; Powell, M.F.</creatorcontrib><description>•Cesarean delivery patients in the enhanced recovery program received fewer opioids.•Average pain scores remained mild despite the reduced opioid consumption.•Fewer than half the patients required an opioid within 24 h of discharge.•Early oral intake was not associated with increased anti-emetic requirements. Cesarean delivery is one of the most common surgeries performed worldwide and the adoption of enhanced recovery programs for cesarean delivery is gaining popularity. We tested the hypothesis that implementation of an enhanced recovery program for cesarean delivery would be associated with a decrease in postoperative opioid consumption. We compared a retrospective cohort of women delivered by elective cesarean delivery (January 1, 2017 to June 30, 2018) to a prospective cohort exposed to the enhanced recovery protocol (July 1, 2018 to December 31, 2018). The primary outcome was inpatient maternal opioid use, measured as total oral morphine equivalents. Secondary outcomes included postoperative 0–10 pain scores, length of stay, 30-day postoperative complication rates, and hospital re-admissions. Data from 541 patients were analyzed. The enhanced recovery cohort used significantly less oral morphine equivalents compared with the pre-enhanced recovery cohort (60.3 mg vs 104.3 mg, P &lt;0.001). The number of patients who required opioid medication within 24 h of discharge was significantly reduced in the enhanced recovery cohort (41.1% vs 74.6%, P &lt;0.001). There were no significant differences in average pain scores (1.6 vs 1.9, P=0.037). The implementation of an enhanced recovery program for cesarean delivery was associated with a significant reduction in postoperative opioid consumption throughout hospitalization, with average pain scores remaining &lt;2. Implementation of this program was also associated with an increase in the number of patients who were opioid-free 24 h prior to discharge.</description><identifier>ISSN: 0959-289X</identifier><identifier>EISSN: 1532-3374</identifier><identifier>DOI: 10.1016/j.ijoa.2020.01.005</identifier><identifier>PMID: 32044216</identifier><language>eng</language><publisher>OXFORD: Elsevier Ltd</publisher><subject>Anesthesiology ; Cesarean delivery ; Life Sciences &amp; Biomedicine ; Obstetrical anesthesia ; Obstetrics &amp; Gynecology ; Opioid analgesics ; Postoperative pain ; Science &amp; Technology</subject><ispartof>International journal of obstetric anesthesia, 2020-08, Vol.43, p.47-55</ispartof><rights>2020 Elsevier Ltd</rights><rights>Copyright © 2020 Elsevier Ltd. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>true</woscitedreferencessubscribed><woscitedreferencescount>22</woscitedreferencescount><woscitedreferencesoriginalsourcerecordid>wos000549352100013</woscitedreferencesoriginalsourcerecordid><citedby>FETCH-LOGICAL-c422t-a7adb80334c3b7a4e50e370e9e9bfa95b5679bd4b5df4ef95cc7f32b14dd55123</citedby><cites>FETCH-LOGICAL-c422t-a7adb80334c3b7a4e50e370e9e9bfa95b5679bd4b5df4ef95cc7f32b14dd55123</cites><orcidid>0000-0001-5574-6473</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.ijoa.2020.01.005$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>315,782,786,3552,27931,27932,28255,46002</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32044216$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Lester, S.A.</creatorcontrib><creatorcontrib>Kim, B.</creatorcontrib><creatorcontrib>Tubinis, M.D.</creatorcontrib><creatorcontrib>Morgan, C.J.</creatorcontrib><creatorcontrib>Powell, M.F.</creatorcontrib><title>Impact of an enhanced recovery program for cesarean delivery on postoperative opioid use</title><title>International journal of obstetric anesthesia</title><addtitle>INT J OBSTET ANESTH</addtitle><addtitle>Int J Obstet Anesth</addtitle><description>•Cesarean delivery patients in the enhanced recovery program received fewer opioids.•Average pain scores remained mild despite the reduced opioid consumption.•Fewer than half the patients required an opioid within 24 h of discharge.•Early oral intake was not associated with increased anti-emetic requirements. Cesarean delivery is one of the most common surgeries performed worldwide and the adoption of enhanced recovery programs for cesarean delivery is gaining popularity. We tested the hypothesis that implementation of an enhanced recovery program for cesarean delivery would be associated with a decrease in postoperative opioid consumption. We compared a retrospective cohort of women delivered by elective cesarean delivery (January 1, 2017 to June 30, 2018) to a prospective cohort exposed to the enhanced recovery protocol (July 1, 2018 to December 31, 2018). The primary outcome was inpatient maternal opioid use, measured as total oral morphine equivalents. Secondary outcomes included postoperative 0–10 pain scores, length of stay, 30-day postoperative complication rates, and hospital re-admissions. Data from 541 patients were analyzed. The enhanced recovery cohort used significantly less oral morphine equivalents compared with the pre-enhanced recovery cohort (60.3 mg vs 104.3 mg, P &lt;0.001). The number of patients who required opioid medication within 24 h of discharge was significantly reduced in the enhanced recovery cohort (41.1% vs 74.6%, P &lt;0.001). There were no significant differences in average pain scores (1.6 vs 1.9, P=0.037). The implementation of an enhanced recovery program for cesarean delivery was associated with a significant reduction in postoperative opioid consumption throughout hospitalization, with average pain scores remaining &lt;2. Implementation of this program was also associated with an increase in the number of patients who were opioid-free 24 h prior to discharge.</description><subject>Anesthesiology</subject><subject>Cesarean delivery</subject><subject>Life Sciences &amp; Biomedicine</subject><subject>Obstetrical anesthesia</subject><subject>Obstetrics &amp; Gynecology</subject><subject>Opioid analgesics</subject><subject>Postoperative pain</subject><subject>Science &amp; Technology</subject><issn>0959-289X</issn><issn>1532-3374</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>AOWDO</sourceid><recordid>eNqNkU1rFTEUhoMo9lr9Ay4kS0FmzOedCbiRi9ZCoZsWugv5ONFc7kzGZKbSf9_czrVLcZVD8ryHk-cg9J6SlhK6_bxv4z6ZlhFGWkJbQuQLtKGSs4bzTrxEG6Kkaliv7s7Qm1L2hBDF--1rdMYZEYLR7QbdXQ6TcTNOAZsRw_jLjA48zuDSPeQHPOX0M5sBh5Sxg2IyVMzDIT69phFPqcxpgmzmeoXTFFP0eCnwFr0K5lDg3ek8R7ffv93sfjRX1xeXu69XjROMzY3pjLc94Vw4bjsjQBLgHQEFygajpJXbTlkvrPRBQFDSuS5wZqnwXkrK-Dn6uPatk_5eoMx6iMXB4WBGSEvRjEsue17lVJStqMuplAxBTzkOJj9oSvTRqN7ro1F9NKoJ1Wvow6n_Ygfwz5G_CivQr8AfsCkUF6EafMaqcykUl4zWivJdnKuoNO7SMs41-un_o5X-stJQdd5HyPqU8LGua9Y-xX995BFEFqlB</recordid><startdate>20200801</startdate><enddate>20200801</enddate><creator>Lester, S.A.</creator><creator>Kim, B.</creator><creator>Tubinis, M.D.</creator><creator>Morgan, C.J.</creator><creator>Powell, M.F.</creator><general>Elsevier Ltd</general><general>Elsevier</general><scope>AOWDO</scope><scope>BLEPL</scope><scope>DTL</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-5574-6473</orcidid></search><sort><creationdate>20200801</creationdate><title>Impact of an enhanced recovery program for cesarean delivery on postoperative opioid use</title><author>Lester, S.A. ; Kim, B. ; Tubinis, M.D. ; Morgan, C.J. ; Powell, M.F.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c422t-a7adb80334c3b7a4e50e370e9e9bfa95b5679bd4b5df4ef95cc7f32b14dd55123</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Anesthesiology</topic><topic>Cesarean delivery</topic><topic>Life Sciences &amp; Biomedicine</topic><topic>Obstetrical anesthesia</topic><topic>Obstetrics &amp; Gynecology</topic><topic>Opioid analgesics</topic><topic>Postoperative pain</topic><topic>Science &amp; Technology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Lester, S.A.</creatorcontrib><creatorcontrib>Kim, B.</creatorcontrib><creatorcontrib>Tubinis, M.D.</creatorcontrib><creatorcontrib>Morgan, C.J.</creatorcontrib><creatorcontrib>Powell, M.F.</creatorcontrib><collection>Web of Science - Science Citation Index Expanded - 2020</collection><collection>Web of Science Core Collection</collection><collection>Science Citation Index Expanded</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>International journal of obstetric anesthesia</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Lester, S.A.</au><au>Kim, B.</au><au>Tubinis, M.D.</au><au>Morgan, C.J.</au><au>Powell, M.F.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Impact of an enhanced recovery program for cesarean delivery on postoperative opioid use</atitle><jtitle>International journal of obstetric anesthesia</jtitle><stitle>INT J OBSTET ANESTH</stitle><addtitle>Int J Obstet Anesth</addtitle><date>2020-08-01</date><risdate>2020</risdate><volume>43</volume><spage>47</spage><epage>55</epage><pages>47-55</pages><issn>0959-289X</issn><eissn>1532-3374</eissn><abstract>•Cesarean delivery patients in the enhanced recovery program received fewer opioids.•Average pain scores remained mild despite the reduced opioid consumption.•Fewer than half the patients required an opioid within 24 h of discharge.•Early oral intake was not associated with increased anti-emetic requirements. Cesarean delivery is one of the most common surgeries performed worldwide and the adoption of enhanced recovery programs for cesarean delivery is gaining popularity. We tested the hypothesis that implementation of an enhanced recovery program for cesarean delivery would be associated with a decrease in postoperative opioid consumption. We compared a retrospective cohort of women delivered by elective cesarean delivery (January 1, 2017 to June 30, 2018) to a prospective cohort exposed to the enhanced recovery protocol (July 1, 2018 to December 31, 2018). The primary outcome was inpatient maternal opioid use, measured as total oral morphine equivalents. Secondary outcomes included postoperative 0–10 pain scores, length of stay, 30-day postoperative complication rates, and hospital re-admissions. Data from 541 patients were analyzed. The enhanced recovery cohort used significantly less oral morphine equivalents compared with the pre-enhanced recovery cohort (60.3 mg vs 104.3 mg, P &lt;0.001). The number of patients who required opioid medication within 24 h of discharge was significantly reduced in the enhanced recovery cohort (41.1% vs 74.6%, P &lt;0.001). There were no significant differences in average pain scores (1.6 vs 1.9, P=0.037). The implementation of an enhanced recovery program for cesarean delivery was associated with a significant reduction in postoperative opioid consumption throughout hospitalization, with average pain scores remaining &lt;2. Implementation of this program was also associated with an increase in the number of patients who were opioid-free 24 h prior to discharge.</abstract><cop>OXFORD</cop><pub>Elsevier Ltd</pub><pmid>32044216</pmid><doi>10.1016/j.ijoa.2020.01.005</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0001-5574-6473</orcidid></addata></record>
fulltext fulltext
identifier ISSN: 0959-289X
ispartof International journal of obstetric anesthesia, 2020-08, Vol.43, p.47-55
issn 0959-289X
1532-3374
language eng
recordid cdi_pubmed_primary_32044216
source Web of Science - Science Citation Index Expanded - 2020<img src="https://exlibris-pub.s3.amazonaws.com/fromwos-v2.jpg" />; Access via ScienceDirect (Elsevier)
subjects Anesthesiology
Cesarean delivery
Life Sciences & Biomedicine
Obstetrical anesthesia
Obstetrics & Gynecology
Opioid analgesics
Postoperative pain
Science & Technology
title Impact of an enhanced recovery program for cesarean delivery on postoperative opioid use
url https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-12-05T16%3A26%3A22IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_pubme&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Impact%20of%20an%20enhanced%20recovery%20program%20for%20cesarean%20delivery%20on%20postoperative%20opioid%20use&rft.jtitle=International%20journal%20of%20obstetric%20anesthesia&rft.au=Lester,%20S.A.&rft.date=2020-08-01&rft.volume=43&rft.spage=47&rft.epage=55&rft.pages=47-55&rft.issn=0959-289X&rft.eissn=1532-3374&rft_id=info:doi/10.1016/j.ijoa.2020.01.005&rft_dat=%3Cproquest_pubme%3E2353583005%3C/proquest_pubme%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2353583005&rft_id=info:pmid/32044216&rft_els_id=S0959289X20300224&rfr_iscdi=true