Multimodal Pain Management for Cesarean Delivery

A Double-Blinded, Placebo-Controlled, Randomized Clinical Trial

Emily E. Hadley, Luis Monsivais, Lucia Pacheco, Rovnat Babazade, Giuseppe Chiossi, Yara Ramirez, Viviana Ellis, Michelle Simon, George R. Saade, Maged Costantine

Research output: Contribution to journalArticle

Abstract

Objective Our objective was to evaluate the efficacy of perioperative multimodal pain management in reducing opioid use after elective cesarean delivery (CD). Study Design A single-center, double-blinded, placebo-controlled randomized trial of women undergoing elective CD. Participants were allocated 1:1 to receive the multimodal protocol or matching placebos. The multimodal protocol consisted of a preoperative dose of intravenous acetaminophen, preincision injection of subcutaneous bupivacaine, and intraoperative injection of intramuscular ketorolac. Primary outcome was total opioid intake at 48 hours postoperatively. Secondary outcomes were pain scores, time to first opioid intake, neonatal outcomes, and total outpatient opioid intake on postoperative day (POD) 7. Data were analyzed using parametric and nonparametric tests and quantile regression as appropriate. Results A total of 242 women were screened with 120 randomized, 60 to the multimodal group and 60 to control group. There was no significant difference in the primary outcome of opioid use nor in the secondary outcomes. Smokers and patients with a history of drug use had higher median postoperative opiate use and earlier administration. On POD 7, only 40% of prescribed opioids had been used, and there was no difference between the groups. Conclusion This perioperative multimodal pain regimen did not reduce opioid use in 48 hours after CD. Patients who smoke or with a history of drug use required more opioids in the postoperative period. Providers significantly overprescribed opioids after CD.

Original languageEnglish (US)
Pages (from-to)1097-1105
Number of pages9
JournalAmerican Journal of Perinatology
Volume36
Issue number11
DOIs
StatePublished - Jan 1 2019

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Pain Management
Opioid Analgesics
Randomized Controlled Trials
Placebos
Opiate Alkaloids
Ketorolac
Pain
Bupivacaine
Intramuscular Injections
Subcutaneous Injections
Acetaminophen
Postoperative Period
Smoke
Pharmaceutical Preparations
Outpatients
Control Groups

Keywords

  • cesarean delivery
  • multimodal
  • opioid use
  • pain management
  • postpartum

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Obstetrics and Gynecology

Cite this

Multimodal Pain Management for Cesarean Delivery : A Double-Blinded, Placebo-Controlled, Randomized Clinical Trial. / Hadley, Emily E.; Monsivais, Luis; Pacheco, Lucia; Babazade, Rovnat; Chiossi, Giuseppe; Ramirez, Yara; Ellis, Viviana; Simon, Michelle; Saade, George R.; Costantine, Maged.

In: American Journal of Perinatology, Vol. 36, No. 11, 01.01.2019, p. 1097-1105.

Research output: Contribution to journalArticle

Hadley, EE, Monsivais, L, Pacheco, L, Babazade, R, Chiossi, G, Ramirez, Y, Ellis, V, Simon, M, Saade, GR & Costantine, M 2019, 'Multimodal Pain Management for Cesarean Delivery: A Double-Blinded, Placebo-Controlled, Randomized Clinical Trial', American Journal of Perinatology, vol. 36, no. 11, pp. 1097-1105. https://doi.org/10.1055/s-0039-1681096
Hadley, Emily E. ; Monsivais, Luis ; Pacheco, Lucia ; Babazade, Rovnat ; Chiossi, Giuseppe ; Ramirez, Yara ; Ellis, Viviana ; Simon, Michelle ; Saade, George R. ; Costantine, Maged. / Multimodal Pain Management for Cesarean Delivery : A Double-Blinded, Placebo-Controlled, Randomized Clinical Trial. In: American Journal of Perinatology. 2019 ; Vol. 36, No. 11. pp. 1097-1105.
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