Abstract
We investigated the effect of a standardized care protocol and multimodal analgesic order set emphasizing non-opioid medications with limited rescue oxycodone on opioid exposure.
This single-center retrospective study examined vaginal delivery patients in 2018 (pre-protocol) and 2023 (post-protocol). Outcomes included inpatient opioid use, milligram morphine equivalents, and outpatient opioid prescriptions. Multivariable regression analyzed associations with clinical and demographic covariates.
Unadjusted inpatient opioid administration decreased from 40.85% (2018, n = 2666) to 5.87% (2023, n = 2316) (P < 0.001), and among those administered opioids, there was an average decrease of 11.2 mg morphine equivalents (P < 0.001). Adjusted models showed White patients were 25% less likely to receive an inpatient opioid and given 2.98 mg morphine equivalents less compared to Black patients (P < 0.001). Outpatient prescription rates declined from unadjusted 19.2% to 1.9% (P < 0.001).
Implementation of a multimodal analgesia regimen was associated with significant reductions in opioid exposure after vaginal delivery.
•Opioid-sparing protocols for patients undergoing vaginal delivery are relatively understudied.•Implementation of a multimodal analgesia regimen can reduce postpartum opioid exposure for vaginal delivery patients.•Obstetric anesthesiologists can lead development of institutional opioid-sparing protocols for postpartum patients.