Multimodal Pain Management for Cesarean Delivery: A Double-Blinded, Placebo-Controlled, Randomized Clinical Trial

• DOI: 10.1055/s-0039-1681096
• Publication Date: 2019-03-01T19:25:01Z
• Authors: Emily E. Hadley; Luis Monsivais; Lucia Pacheco; Rovnat Babazade; Giuseppe Chiossi; Yara Ramirez; Viviana Ellis; Michelle Simon; George R. Saade; Maged Costantine
• Keywords: Acetaminophen

Objective Our objective was to evaluate the efficacy of perioperative multimodal pain management in reducing opioid use after elective cesarean delivery (CD). Study Design A single-center, double-blinded, placebo-controlled randomized trial women undergoing CD. Participants were allocated 1:1 receive protocol or matching placebos. The consisted a preoperative dose intravenous acetaminophen, preincision injection subcutaneous bupivacaine, and intraoperative intramuscular ketorolac. Primary outcome total intake at 48 hours postoperatively. Secondary outcomes scores, time first intake, neonatal outcomes, outpatient on postoperative day (POD) 7. Data analyzed using parametric nonparametric tests quantile regression as appropriate. Results 242 screened with 120 randomized, 60 group control group. There no significant difference primary nor secondary outcomes. Smokers patients history drug had higher median opiate earlier administration. On POD 7, only 40% prescribed opioids been used, there between groups. Conclusion This regimen did not reduce Patients who smoke required more period. Providers significantly overprescribed