(861) Opioid-Sparing Protocol and Post-Cesarean Opioid Prescription among Individuals with Substance Use Disorders

Objective:
In response to rising deliveries complicated by substance use disorder (SUD), particularly opioid and stimulant use disorders, our institution implemented an opioid-sparing (OS) postpartum pain protocol in 2018, incorporating epidural and/or low-dose ketamine infusions with multimodal analgesia (scheduled acetaminophen, ibuprofen or ketorolac, and pregabalin). We aimed to evaluate the association between the OS protocol and opioid prescriptions at discharge following cesarean birth in individuals with SUD.

Study Design:

We conducted a retrospective cohort study of individuals who underwent cesarean birth at a single academic hospital from Jan 2018 to Dec 2023. Three groups were compared: (1) individuals with SUD who received the OS protocol, (2) individuals with SUD who received standard pain management (scheduled acetaminophen, ibuprofen, and as-needed oxycodone), and (3) a control group without SUD who received standard management (one individual randomly selected per month of study period). The primary outcome was opioid prescription at discharge. Logistic regression estimated the association, adjusted for confounders.

Results:

 

We included 273 individuals: 189 with SUD who received OS, 33 with SUD and standard management, and 51 controls. Demographic and clinical characteristics differed between groups (Table 1). Among OS recipients, 63.5% received both ketamine and epidural, 18.5% ketamine only, and 18.0% epidural only. Compared to controls, the OS group had over 90% lower odds of opioid prescription at discharge (88.2% vs. 18.5%; aOR 0.08, 95% CI 0.02–0.30) (Figure 1). There was no significant difference between the control group and the SUD group with standard management (88.2% vs. 66.7%; aOR 0.42, 95% CI 0.11–3.43).


Conclusion:

At a single institution, the OS pain management protocol significantly reduced post-cesarean opioid prescriptions among individuals with SUD.