Research Day
ASSESSMENT OF IMPLEMENTATION OF STANDARDIZED POST-CESAREAN SECTION PAIN MANAGEMENT ORDERS ON MORPHINE MILLIGRAM EQUIVALENTS (MME) IN THE POST-OPERATIV
Document Type
Abstract
Date
2021
Abstract
Primary objective: Evaluation of the change in opioid use in hospital after Cesarean delivery following implementation of multimodal pain management orders.
Secondary objective: Evaluation of patient pain score ratings in the post-implementation period. Intervention: The standard post-C/Section Order set was changed to include pre-checked orders for NSAIDs and acetaminophen. IV morphine, IV hydromorphone and PO oxycodone remain available but require providers to actively prescribe them. Also available was infiltration of incision with local anesthetic. MME utilized post-C/Section and daily maximum pain scores were reported. Data was collected by manual chart review.
Results and Discussion: Average MME was 108 pre-intervention and 135 post-intervention, a statistically significant increase. Subgroup analysis was performed in the post-intervention group including only patients treated with incisional local anesthetic, and those who did not utilize opioid PCAs. Median MME was not significantly different in those with and without opioid PCAs. Patients with local infiltration of lidocaine received significantly greater total MME than those without. The difference between the mean maximum pain scores during the pre-intervention and post-intervention was not statistically significant.
Conclusion: Use of standardized post-C/Section multimodal pain management orders resulted in increased opioid use. However, patients treated without PCA had no significant change in opioid use. Pain scores were unchanged suggesting that non-PCA management is satisfactory. Additional analysis should be done into cost comparisons and other benefits of non-PCA management of post-operative pain.