Opioid Prescribing After Cesarean Delivery

Vanderbilt University Medical Center190 enrolled

Overview

The number of opioid overdose deaths in the United States has quadrupled in 15 years, a dramatic manifestation of the current opioid abuse epidemic. This rise parallels a sharp increase in the amount of legal prescription opioids dispensed. The abundance of prescription opioids available is a primary pathway for opioid abuse and diversion. Adjusting post- cesarean delivery opioid prescribing practices to better match actual patient need has the potential to reduce unused opioids available for diversion, nonmedical use, and development of chronic dependence, as well as reduce wasted resources.

Preliminary data from a quality improvement project performed in our department found that most women are prescribed opioids after discharge that were significantly in excess of the actual opioids used. However there is a subset of women (\~25%) who use all opioids and complain that they were not prescribed enough. The only variable predictive of post- discharge opioid use was Inpatient opioid use. These data were used to develop a formula for estimating outpatient use based on inpatient use. Currently there are no guidelines for outpatient prescribing either at our institution or on a national level. On average, most patients at our institution received 30 tablets of 5mg oxycodone at discharge. In surveying providers, very few looked at inpatient use and most had a standard prescription that they gave everyone.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

NONE

Enrollment

190

Conditions

Surgery Opioid Use

Interventions

Tailored prescriptionOTHER

Participants will be prescribed an opioid tablet number based on a formula derived from inpatient opioid use

ControlOTHER

Participants will be prescribed 30 tablets of oxycodone 5mg

Eligibility

Sex: FEMALEMin age: 18 YearsMax age: 50 YearsHealthy volunteers:

Medical Language ↔ Plain English

Inclusion Criteria: * Women 18-50 years old * Women undergoing cesarean delivery at a single institution Exclusion Criteria: * Major post-surgical complications: cesarean hysterectomy, bowl or bladder injury, reoperation, ICU admission, wound infection or separation * Chronic opioid use: Taking buprenorphine during pregnancy, taking an opioid for \> 7 days during pregnancy. * Non English or Spanish speaking

Locations (1)

Sarah Osmundson

Nashville, Tennessee, United States

Outcomes

Primary Outcomes

Unused Opioids

oxycodone 5mg tablet leftover from prescription at discharge

Time frame: 4 weeks postpartum

Secondary Outcomes

Pain: Frequency That Participants Reported Uncontrolled Pain

Frequency that participants reported uncontrolled pain Pain scores were examined based on how many negative responses indicating worse pain were reported to the five questions relating to analgesic adequacy. Thus participants could have a score that ranged from 0 to 5. Question 1 - I was discharged with too few opioid pills (Yes=1, No=0) Question 2 - Overall, my pain is poorly controlled by these medications (Yes=1, No=0) Question 3 - Overall, my pain from delivery has been worse than expected (Yes=1, No=0) Question 4 - Pain interfered significantly with my ability to do normal activities (Yes=1, No=0) Question 5 - Since discharge, I needed more opioid than what was expected (Yes=1, No=0)

Time frame: 4 weeks postpartum

Data from ClinicalTrials.gov

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