Cessation of routine oral opioids following cesarean delivery was linked to a significant reduction in opioid consumption with maintained levels of pain management and patient satisfaction, according to a study published in Obstetrics & Gynecology.

Investigators conducted a quality improvement intervention among faculty practice patients undergoing cesarean delivery to determine the effects of cessation of routine oral opioids for postcesarean delivery analgesia on opioid consumption.

The intervention included the elimination of routine oral opioids following cesarean delivery, the implementation of guidelines to order shorter courses of oral opioids when necessary, and linking prescribing opioids at discharge with in-hospital use, along with shared decision-making.

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Before and after the intervention, all patients were administered neuraxial opioids, as well as acetaminophen and nonsteroidal anti-inflammatory medications barring any contraindications.

The main outcome measured was the percentage of patients using any opioids while hospitalized following cesarean delivery. Secondary outcomes included the percentage of patients discharged with an opioid prescription, the quantity of the prescription, the number of opioids used postoperatively prior to discharge, and the number of prescriptions ordered via hospital electronic medical record in the 6 weeks following delivery, as well as any reported postoperative pain, satisfaction with pain management, and any opioid-related side effects.

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Of the 414 recorded cesarean deliveries, 372 were included in the study; 191 postcesarean delivery patients were monitored prior to the intervention and 181 were monitored after the intervention.

Following cesarean delivery, 68.1% of nonintervention patients were administered opioids while in the hospital compared with 45.3% of intervention patients.

The investigators noted that there was no significant change in pain scores or patient satisfaction after the intervention. In addition, after the intervention 40.3% of patients were discharged with opioid prescriptions compared with 90.6% receiving an opioid prescription prior to the intervention.

“The American College of Obstetricians and Gynecologists recommends that opioid medication should be an adjunct for patients with uncontrolled pain despite adequate first-line nonopioid therapy,” the authors wrote. “Consistent with this, our study’s findings show that, although opioids should be available for patients who need them, they do not need to be ordered routinely for patients after cesarean delivery.”


Holland E, Bateman BT, Cole N, et al. Evaluation of a quality improvement intervention that eliminated routine use of opioids after cesarean delivery. Obstet Gynecol. 2019;133(1):91-97.