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CME Credit Offered
CME Credit Offered
Abstract Award
Abstract Award
Recording available 2/16-5/2
Recording available 2/16-5/2
AIUM Credit
AIUM Credit
Foundation Awardee
Foundation Awardee
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Abstract Award
Abstract Award
Foundation Awardee
Foundation Awardee

Poster Session 1

Category: Operative Obstetrics

Poster Session 1

(243) Increased Opioid Use in Patients with NSAID Contraindications After Cesarean Hysterectomy

Wednesday, February 11, 2026
10:30 AM - 12:00 PM  
Objective:
To investigate whether patients undergoing cesarean hysterectomies with contraindications (CI) to nonsteroidal anti-inflammatory drugs (NSAIDs) utilize more opioids via patient-controlled analgesia (PCA) during postoperative admission.

Study Design:
A retrospective cohort study of all patients who underwent cesarean hysterectomy at a single academic center between 2014 and 2025. Patient characteristics and postoperative PCA administration data were collected through electronic health records. Primary exposure was presence of one or more CI to NSAIDs including ketorolac and ibuprofen; secondary exposure was use of postoperative neuraxial anesthesia (NA). Statistical analysis was completed with unpaired t-test and chi square tests. Primary outcome was mean PCA postoperative morphine equivalents (POME) administered prior to discharge. Secondary outcomes include length of postoperative admission and count of patients with PCA use. 

Results:
215 patients were included in the study. 12 (5.6%) patients had CI to NSAIDs, 5 (42%) of which received postoperative NA. 203 (94%) patients did not have a CI, of which 46 (23%) received NA. Patients with CI utilized significantly more POME and had longer postoperative admissions (Table 1; p < 0.0001 for both), despite similar PCA use (p = 0.1192). When comparing patients with CI who used NA, and patients without CI who did not use NA, total mean POME and hospital length of stay were significantly higher in patients with CI (Table 2, p < 0.0001 for both).

Conclusion:
Increased opioid exposure is associated with a higher risk of prolonged opioid use, dependence, and opioid use disorder. Our results suggest increased exposure to opioids during longer postoperative admissions in patients with CI to NSAIDs, which was not normalized with NA use. To minimize exposure to opioids, multimodality pain control strategies are warranted in patients with NSAID CIs including interrogation of the etiology of the CI, allergy testing when indicated, and consideration for adjunctive nonpharmacologic modalities.