Implementation of a Standardized Post-Cesarean Delivery Order Set with Multimodal Combination Analgesia Reduces Inpatient Opioid Usage
<b>Background:</b> Opioid use has emerged as a leading cause of death in the US. Given that 1 in 300 opioid-naive patients exposed to opioids after cesarean birth will become persistent users, hospitals should strive to limit exposure to these medications. We set out to evaluate whether...
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| Format: | Article |
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MDPI AG
2020-12-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/10/1/7 |
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| author | Eran Bornstein Gregg Husk Erez Lenchner Amos Grunebaum Therese Gadomski Cristina Zottola Sarah Werner Jamie S. Hirsch Frank A. Chervenak |
| author_facet | Eran Bornstein Gregg Husk Erez Lenchner Amos Grunebaum Therese Gadomski Cristina Zottola Sarah Werner Jamie S. Hirsch Frank A. Chervenak |
| author_sort | Eran Bornstein |
| collection | DOAJ |
| description | <b>Background:</b> Opioid use has emerged as a leading cause of death in the US. Given that 1 in 300 opioid-naive patients exposed to opioids after cesarean birth will become persistent users, hospitals should strive to limit exposure to these medications. We set out to evaluate whether transitioning to a standardized order set based on multimodal combination analgesic therapy decreases the exposure to opioids after cesarean delivery. <b>Methods:</b> Our health system’s post-cesarean pain management electronic medical record (EMR) order set was changed from standing NSAIDs (Ibuprofen 600 mg every 6 h) and additional acetaminophen and opioid medications (Oxycodone 5 mg/acetaminophen 325 mg every 3 h or Oxycodone 10 mg/acetaminophen 650 mg every 6 h for moderate and severe pain, respectively) as needed (PRN) to a multimodal combination therapy with acetaminophen (975 mg every 6 h) and NSAIDs (Ibuprofen 600 mg every 6 h) as primary analgesics and opioids PRN (Oxycodone immediate release (IR) 5 mg every 3 h for moderate to severe pain). We performed a retrospective analysis across seven hospitals comparing inpatient opioid use, administration of other analgesics, and severe pain episodes (pain score ≥ 7) between the patients who were treated before and after implementation of the multimodal order set. Chi square and Student <i>t</i>-test were used for statistical analysis with significance determined as <i>p</i> < 0.05. <b>Results:</b> A total of 12,898 cesarean births were included (8696 prior and 4202 after implementation). The multimodal order set was associated with marked decrease in the incidence of post cesarean opioid use (45.4% vs. 67.5%; <i>p</i> < 0.0001), lower average opioid dose (26.7 mg vs. 36.6 mg of oxycodone; <i>p</i> < 0.0001), and increased dose of acetaminophen (8422 mg vs. 4563 mg; <i>p</i> < 0.0001), while severe pain scores were less frequent (46.3% vs. 56.6%, <i>p</i> < 0.0001). <b>Conclusions:</b> Multimodal analgesic therapy for post-cesarean pain management reduces inpatient opioid use while improving pain control. Incorporation of a multimodal order set as a default in the EMR facilitates effective and widespread implementation on a large scale. Obstetric units should consider standardizing post-cesarean pain management orders to include routine (not PRN) multimodal combination therapy with acetaminophen and NSAIDs as primary analgesics. |
| first_indexed | 2024-03-10T13:51:15Z |
| format | Article |
| id | doaj.art-ebcaae18755c48dabec6d70adc86973e |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-10T13:51:15Z |
| publishDate | 2020-12-01 |
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| series | Journal of Clinical Medicine |
| spelling | doaj.art-ebcaae18755c48dabec6d70adc86973e2023-11-21T02:07:17ZengMDPI AGJournal of Clinical Medicine2077-03832020-12-01101710.3390/jcm10010007Implementation of a Standardized Post-Cesarean Delivery Order Set with Multimodal Combination Analgesia Reduces Inpatient Opioid UsageEran Bornstein0Gregg Husk1Erez Lenchner2Amos Grunebaum3Therese Gadomski4Cristina Zottola5Sarah Werner6Jamie S. Hirsch7Frank A. Chervenak8Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Lenox Hill Hospital—Northwell Health/Zucker School of Medicine, New York, NY 10075, USADepartment of Medical Informatics, Lenox Hill Hospital—Northwell Health/Zucker School of Medicine, New York, NY 10075, USADepartment of Biostatistics and Data Management, New York University Rory Meyers College of Nursing, New York, NY 10010, USADivision of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Lenox Hill Hospital—Northwell Health/Zucker School of Medicine, New York, NY 10075, USADivision of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Lenox Hill Hospital—Northwell Health/Zucker School of Medicine, New York, NY 10075, USADivision of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Lenox Hill Hospital—Northwell Health/Zucker School of Medicine, New York, NY 10075, USADivision of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Lenox Hill Hospital—Northwell Health/Zucker School of Medicine, New York, NY 10075, USADivision of Kidney Diseases and Hypertension, Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Great Neck, NY 11030, USADivision of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Lenox Hill Hospital—Northwell Health/Zucker School of Medicine, New York, NY 10075, USA<b>Background:</b> Opioid use has emerged as a leading cause of death in the US. Given that 1 in 300 opioid-naive patients exposed to opioids after cesarean birth will become persistent users, hospitals should strive to limit exposure to these medications. We set out to evaluate whether transitioning to a standardized order set based on multimodal combination analgesic therapy decreases the exposure to opioids after cesarean delivery. <b>Methods:</b> Our health system’s post-cesarean pain management electronic medical record (EMR) order set was changed from standing NSAIDs (Ibuprofen 600 mg every 6 h) and additional acetaminophen and opioid medications (Oxycodone 5 mg/acetaminophen 325 mg every 3 h or Oxycodone 10 mg/acetaminophen 650 mg every 6 h for moderate and severe pain, respectively) as needed (PRN) to a multimodal combination therapy with acetaminophen (975 mg every 6 h) and NSAIDs (Ibuprofen 600 mg every 6 h) as primary analgesics and opioids PRN (Oxycodone immediate release (IR) 5 mg every 3 h for moderate to severe pain). We performed a retrospective analysis across seven hospitals comparing inpatient opioid use, administration of other analgesics, and severe pain episodes (pain score ≥ 7) between the patients who were treated before and after implementation of the multimodal order set. Chi square and Student <i>t</i>-test were used for statistical analysis with significance determined as <i>p</i> < 0.05. <b>Results:</b> A total of 12,898 cesarean births were included (8696 prior and 4202 after implementation). The multimodal order set was associated with marked decrease in the incidence of post cesarean opioid use (45.4% vs. 67.5%; <i>p</i> < 0.0001), lower average opioid dose (26.7 mg vs. 36.6 mg of oxycodone; <i>p</i> < 0.0001), and increased dose of acetaminophen (8422 mg vs. 4563 mg; <i>p</i> < 0.0001), while severe pain scores were less frequent (46.3% vs. 56.6%, <i>p</i> < 0.0001). <b>Conclusions:</b> Multimodal analgesic therapy for post-cesarean pain management reduces inpatient opioid use while improving pain control. Incorporation of a multimodal order set as a default in the EMR facilitates effective and widespread implementation on a large scale. Obstetric units should consider standardizing post-cesarean pain management orders to include routine (not PRN) multimodal combination therapy with acetaminophen and NSAIDs as primary analgesics.https://www.mdpi.com/2077-0383/10/1/7multimodal analgesicsopioidopioid usenarcoticspost-partum pain controlpost-cesarean pain control |
| spellingShingle | Eran Bornstein Gregg Husk Erez Lenchner Amos Grunebaum Therese Gadomski Cristina Zottola Sarah Werner Jamie S. Hirsch Frank A. Chervenak Implementation of a Standardized Post-Cesarean Delivery Order Set with Multimodal Combination Analgesia Reduces Inpatient Opioid Usage Journal of Clinical Medicine multimodal analgesics opioid opioid use narcotics post-partum pain control post-cesarean pain control |
| title | Implementation of a Standardized Post-Cesarean Delivery Order Set with Multimodal Combination Analgesia Reduces Inpatient Opioid Usage |
| title_full | Implementation of a Standardized Post-Cesarean Delivery Order Set with Multimodal Combination Analgesia Reduces Inpatient Opioid Usage |
| title_fullStr | Implementation of a Standardized Post-Cesarean Delivery Order Set with Multimodal Combination Analgesia Reduces Inpatient Opioid Usage |
| title_full_unstemmed | Implementation of a Standardized Post-Cesarean Delivery Order Set with Multimodal Combination Analgesia Reduces Inpatient Opioid Usage |
| title_short | Implementation of a Standardized Post-Cesarean Delivery Order Set with Multimodal Combination Analgesia Reduces Inpatient Opioid Usage |
| title_sort | implementation of a standardized post cesarean delivery order set with multimodal combination analgesia reduces inpatient opioid usage |
| topic | multimodal analgesics opioid opioid use narcotics post-partum pain control post-cesarean pain control |
| url | https://www.mdpi.com/2077-0383/10/1/7 |
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