Boston—Involving new mothers in the decision about pain control after Cesarean delivery significantly reduced the amount of opioids they received, according to new research suggesting significant overprescription of the painkillers.
The report, published online in Obstetrics & Gynecology, notes that 1.4 million C-sections are performed each year, making it the most common inpatient surgical procedure in the United States. Oxycodone most commonly is prescribed to women following C-section, but how much is prescribed varies greatly, note researchers from Brigham and Women’s Hospital.
Furthermore, it hasn’t been clear how much pain medication actually is needed or used.
In two reports, researchers calculated the number of pills that are typically prescribed following Cesarean delivery and also tested a shared decision-making tool in which patients select the amount of medication they are prescribed.
“We know that leftover medications are fueling our current opioid epidemic,” explained corresponding author Brian Bateman, MD, chief of Obstetric Anesthesia at Brigham and Women’s. “Quantifying the amount of medication that a woman needs to control her pain following Cesarean delivery and finding ways to reduce unnecessary prescribing can reduce unused opioid pills that end up in medicine cabinets at home.”
For the first study, 720 women from six academic medical centers in the U.S. were surveyed. Results indicate a variation in how opioids were prescribed following Cesarean delivery, with 40 pills as the median, which was many more than what patients really used.
In fact, the researchers report that the women typically received double the number of pills than they needed and had about 15 leftover pills. Two weeks after discharge from the hospital, 95% of patients had not disposed of the excess.
“This was especially interesting to us, because it suggests that we are setting patient expectations based on the number of pills that we prescribe,” Bateman said.
In the second study, researchers tested the use of a shared decision-making tool with 50 women who delivered at Massachusetts General Hospital. After reviewing a table-based decision aid with a clinician, the new mothers chose the number of pills—5 mg of oxycodone—that they would be prescribed at discharge, up to the institutional standard of 40 pills. The result was a 50% decrease in the number of opioid pills prescribed at the time of discharge, according to the report.
While no difference in pain scores was detected when comparing women by the number of pain pills they received, those who got more pills had a higher risk of side effects such as drowsiness, nausea or vomiting, and constipation, researchers note.
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