Enhanced Recovery Efforts for Cesarean Delivery Reduce Opioid Use by 80%

When conducting a cesarean delivery, the use of a wound infusion pump in combination with enhanced recovery efforts, such as earlier removal of urinary catheters and walking around the day of surgery, was found to reduce opioid use by more than 80%, according to a retrospective analysis of cesarean deliveries from 2015 through 2020 conducted at the Colorado Fetal Care Center at Children's Hospital Colorado (Children's Colorado).

Notably, the physicians on the team at Children's Colorado observed that if these enhanced recovery efforts were applied, one-third of patients found that they did not need to take any narcotic pain pills following the cesarean delivery.

"In line with our work to reduce opioid usage with the wound infusion pump, we wanted to see if enhanced recovery efforts in combination with the pump would further reduce the need for narcotic pain medicine," said co-research lead Cristina Wood, MD, an obstetric anesthesiologist at Children's Colorado, in a press release. "These are moms who are going through so much already. We want to do everything we can to help them care for and interact with their baby, while providing optimum pain control."

Cesarean delivery accounts for 32% of all deliveries and is one of the most common surgical procedures conducted in the United States, according to the CDC's National Center for Health Statistics. Generally, health care providers who perform a high number of cesarean deliveries for high-risk pregnancies use a multimodal pain management regimen that includes opioids.

"As concerns about the use of opioids grew and literature on the effectiveness of wound infusion pumps was inconsistent, we saw an opportunity for improvement," said co-research lead Frank Chow, MD, and obstetrician at Children's Colorado, in the press release. "And the improvement was striking. Using enhanced recovery efforts such as scheduling non-narcotic medications postoperatively, limiting intraoperative IV fluids to reduce bowel swelling, implementing prophylactic anti-nausea medication, removing urinary catheters earlier and ambulating the same day of surgery in combination with the wound infusion pump resulted in a dramatic reduction in narcotic pain medication."

Following the Colorado Fetal Care Center receiving the Center of Excellence designation from the Society for Obstetric Anesthesia and Perinatology in 2019, more focus was given to enhanced recovery after cesarean deliveries in order to improve the recovery process for patients.

REFERENCE

Enhanced recovery efforts for cesarean delivery reduce need for opioids by 80%. Aurora, Colorado: Children's Hospital Colorado; January 28, 2021. https://www.eurekalert.org/pub_releases/2021-01/chc-ere012721.php. Accessed January 29, 2021.