Journal Article

Impact of patient choice for different postcesarean delivery analgesic protocols on opioid consumption: a randomized prospective clinical trial

Sutton, Caitlin Dooley, Flood, Pamela Dru, Carvalho, Brendan, Kowalczyk, John J

2019

Overview

BackgroundChoice of postcesarean delivery analgesic protocol may improve pain experience and reduce analgesic requirements.MethodsCesarean delivery patients were randomly assigned either to choose their postcesarean delivery analgesia protocol or to have no choice and receive routine care. Choices were low (50 μg intrathecal morphine), medium (identical to routine care: 150 μg intrathecal morphine), or high (300 μg intrathecal morphine with 600 mg oral gabapentin). All groups received scheduled acetaminophen and ibuprofen. The primary outcome was oxycodone requirements 0–48 hours postdelivery in those offered versus not offered a choice.ResultsOf 160 women enrolled, 120 were offered a choice and 40 were not offered a choice. There was no difference in oxycodone requirements or pain associated with choice, but those who had a choice expressed more satisfaction than those who did not have a choice (mean (95% CI) difference 5% (0% to 10 %), p=0.005). In the choice group, the high dose group required more oxycodone (5 (0 to 15) mg 0–24 hours after delivery and 15 (10 to 25) mg at 24–48 hours; p=0.05 and p=0.001) versus the low and medium groups. The low dose group had less pruritus (p=0.001), while the high dose group had more vomiting (p=0.01) requiring antiemetic treatment (p=0.04).ConclusionHaving a choice compared with no choice routine care did not reduce oxycodone requirements or pain scores. However, women have insight into their analgesic needs; women offered a choice and who chose the higher dose analgesic protocol required more oxycodone, and women who chose the lower dose protocol required less oxycodone. Despite providing additional analgesic (six times more intrathecal morphine plus gabapentin in high dose vs low dose protocols), we still did not equalize postcesarean oxycodone requirement differences between groups.Trial registration number NCT02605187.

• Publisher: BMJ Publishing Group Ltd,Copyright by American Society of Regional Anesthesia and Pain Medicine,BMJ Publishing Group LTD
• Subject: Administration, Oral / Adult / Analgesics / Analgesics - administration & dosage / Analgesics, Opioid - administration & dosage / Anesthesia / Anti-inflammatory agents / Cesarean section / Cesarean Section - adverse effects / Cesarean Section - psychology / Data collection / Decision making / Drug Delivery Systems - methods / Drug Delivery Systems - psychology / Drug dosages / Epidural / Female / Fentanyl / Gabapentin - administration & dosage / Humans / Injections, Spinal / Morphine / Morphine - administration & dosage / Narcotics / Nausea / obstetrics / Original article / Pain management / pain measurement / pain outcome measurement / Pain, Postoperative - drug therapy / Pain, Postoperative - psychology / Patient Preference - psychology / Patients / postoperative pain / Postoperative period / Pregnancy / Prospective Studies / Pruritus / Regional anesthesia / Single-Blind Method / Surgery / Surgical outcomes / Vomiting