BACKGROUND
The national epidemic of opioid misuse has focused its attention on postpartum analgesic
usage. Adequate pain control achieved with nonopioid pain medications and conservative
measures could reduce the number of opioid pain medications available for misuse and
diversion. Interventions that decrease inpatient opioid use after delivery could reduce
the potential for chronic dependence in postpartum women. Modification of preloaded
electronic order sets to decrease opioid administration has successfully reduced opioid
use following a major abdominal surgery, including cesarean delivery. However, interventions
to reduce opioid use following vaginal delivery are not well described.
OBJECTIVE
We aimed to evaluate the effect of removing opioid medications from postpartum order
sets on medication usage following vaginal delivery.
STUDY DESIGN
We performed a retrospective cohort study of women undergoing a singleton vaginal
delivery at an academic tertiary care center. Our institution removed opioid medications
from postpartum order sets in April 2018. We compared the following 2 delivery cohorts:
the “preintervention” cohort (April 2016–March 2018) and the “postintervention” cohort
(June 2018–July 2018). The primary outcome was postpartum opioid use. The secondary
outcomes were nonopioid analgesic use and discharge with an opioid prescription. We
compared the demographic and obstetrical data, self-reported pain scores, and postpartum
analgesic usage between groups. We determined that a minimum of 138 patients would
be needed in each group to identify a 20% decrease in opioid usage (α=.05; β=.2).
RESULTS
We analyzed 276 subjects: 138 in the preintervention group and 138 in the postintervention
group. The postintervention group was older and more likely to have an operative vaginal
delivery. Otherwise, groups had similar demographic and obstetrical characteristics.
Postpartum opioid use decreased from 56% in the preintervention group to 16% in the
postintervention group, a 71% reduction (P<.001). The incidence of severe pain score (>7) was similar between groups with a
median occurrence of 1 (interquartile range, 0–4) for both (P=.7). The number of opioid discharge prescriptions among those receiving inpatient
opioids was significantly lower in the postintervention group than in the preintervention
group (18% vs 38%, respectively), a 53% decrease (P<.001).
CONCLUSION
Removal of opioids from the postpartum order set was associated with lower rates of
opiate usage following vaginal delivery in a single center without changing the frequency
of severe pain scores. This simple intervention has the potential to reduce opioid
exposure.
Key words
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Article info
Publication history
Published online: May 24, 2021
Accepted:
May 20,
2021
Received in revised form:
May 14,
2021
Received:
March 8,
2021
Footnotes
This study was conducted in St. Louis, Missouri.
The authors report no conflict of interest.
This study received no financial support from any sponsors of any kind in the collection, analysis, and interpretation of data.
Data from this study were presented as a poster (number 272, “Reduction of opioid utilization after vaginal delivery with an electronic health record intervention”) at the 40th annual pregnancy meeting of the Society for Maternal-Fetal Medicine, held virtually, February 3–8, 2020.
Cite this article as: Rimsza RR, Perez WM, Shyken J, et al. Reduction of opioid utilization after vaginal delivery with an electronic health record intervention. Am J Obstet Gynecol MFM 2021;XX:x.ex–x.ex.
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