Poster Session 2
Category: Operative Obstetrics
Poster Session 2
Daniel J. Martingano, DO, MBA, PhD
Clerkship Director, IRB Chair, Associate Program Director / Division Chair
St. John's Episcopal Hospital-South Shore / Lake Erie College of Osteopathic Medicine
St. John's Episcopal Hospital-South Shore / Far Rockaway, New York, United States
Melody Boafo, MD
OB/GYN Resident
St. John's Episcopal Hospital-South Shore
hackettstown, New Jersey, United States
Andrea Rivera, MD
OB/GYN Resident
Wyckoff Heights Medical Center
Wyckoff Heights Medical Center / Brooklyn, New York, United States
Crystal Awad, DO
OB/GYN Resident
Jamaica Hospital Medical Center
Jamaica Hospital Medical Center / Queens, New York, United States
Marwah Al-Dulaimi, MD (she/her/hers)
OB/GYN Resident
St. John's Episcopal Hospital-South Shore
St. John's Episcopal Hospital-South Shore, New York, United States
Sarrah Dominique, MD
OB/GYN Resident
St. John's Episcopal Hospital-South Shore
St. John's Episcopal Hospital-South Shore / Far Rockaway, New York, United States
Samantha Giler, MS
St. John's Episcopal Hospital-South Shore / Lake Erie College of Osteopathic Medicine
St. John's Episcopal Hospital-South Shore / Far Rockaway, New York, United States
Jaina Diaz-Kelly, MS
St. John's Episcopal Hospital-South Shore
St. John's Episcopal Hospital-South Shore / Far Rockaway, New York, United States
Kelly Mondey, MS
St. John's Episcopal Hospital-South Shore
St. John's Episcopal Hospital-South Shore / Far Rockaway, New York, United States
Brenna M. Regan, MS
William Carey University College of Osteopathic Medicine
William Carey University / Hattiesburg, Mississippi, United States
Kristen Henry, MS
St. John's Episcopal Hospital-South Shore
St. John's Episcopal Hospital-South Shore / Far Rockaway, New York, United States
Eddie Santana, DO
MFM Fellow
Good Samaritan University Hospital / NYIT
Good Samaritan University Hospital / West Islip, New York, United States
Angelo Oduro, DO
OBGYN Residency Program Director
St. John's Episcopal Hospital-South Shore / Lake Erie College of Osteopathic Medicine
St. John's Episcopal Hospital-South Shore / Far Rockaway, New York, United States
Jacqueline Marecheau, MD
Chairperson, Department of OB/GYN
St. John's Episcopal Hospital-South Shore
St. John's Episcopal Hospital-South Shore / Far Rockaway, New York, United States
Francis X. Martingano, MD
Minimally Invasive GYN & Complex Obstetric Surgery Specialist
NYU Langone Medical Center / NYU School of Medicine
NYU Langone Medical Center / New York, New York, United States
Enhanced recovery after surgery for cesarean deliveries (ERAS-C) protols provide improved outcomes and mitigation of complications. Non-steroidal anti-inflammatory medications (NSAID) and acetaminophen (APAP) remain a staple therein, making cases contraindications to NSAID and APAP (NXA) challenging. This study sought to evaluate ERAS-C protocols utilizing alternative medication regimens in pregnancies complicated by NXA.
Study Design:
We conducted a multi-center, prospective observational study from 7/2020 to 7/2025 and included all pregnant women with NXA utilizing ERAS-C protocols. Regimens included those that substituted NSAIDs for tramadol and APAP for gabapentin (TX1), and those that substituted NSAIDs for cyclobenzaprine and APAP for pregabalin (TX2). Each regimen was compared to the total patients receiving a different regimen. Both protocols otherwise utilized the same medications and procedures. Primary outcomes included length of stay exceeding 3 days postoperative (LOS), postoperative ileus, need for additional medications (MED), addition of opioid medications (OM), and subsequent emergency room visits for pain (EDP), as discrete events. Patients with multi-fetal gestations, concurrent infectious diseases, diabetes in pregnancy, or intrapartum morphine or butorphanol use were excluded.
Results:
The study included 333 patients, with 183 receiving TX1 and 150 receiving TX2. Baseline demographic factors were not significantly different. Patients receiving TX1 had lower rates of OM (29.5% v. 34.0% p=0.005) and MED (27.3% v. 32.9%, p< 0.001 with an 61% (RR=0.39, 95% CI 0.17-0.22, p=0.003) and 69% (RR=0.31, 95% CI 0.19-0.23, p=0.008) decreased risk in confounder-adjusted models, respectively. Patients receiving TX2 had lower rates of LOS (12.6% v. 16.9% p=0.022) and EDP(10.0% v. 15.3% p=0.040), with a 11% (RR=0.89, 95% CI 0.77-0.96, p=0.045) and 14% (RR=0.86, 95% CI 0.81-0.98, p=0.050) decreased risk in adjusted models.
Conclusion:
Pregabalin, gabapentin, tramadol, and cyclobenzaprine are safe and efficacious alternatives for NSAIDs and APAP, with potential respective benefits for ERAS-C.