Reducing opioid use in patients undergoing C-sections

Consider these statistics: Approximately 1 in 3 babies born in the United States is delivered via cesarean section (C-section).  As many as 7% of surgical patients prescribed an opioid for pain control become persistent users.

As a physician-led national health solutions partner, MEDNAX is committed to helping address the nation’s opioid epidemic. The U.S. Department of Health and Human Services, National Institute of Health, and Centers for Disease Control and Prevention all agree that opioid addiction is a widespread problem and will require, not just one, but multiple solutions and a comprehensive approach.

MEDNAX supports a multi-faceted approach to problem solving and offer a variety of initiatives to address opioid-related disorders and opioid management, including the Enhanced Recovery After Surgery (ERAS) program. Obstetrix Medical Group of San Jose (OBX), a MEDNAX affiliate, is one of six practices with ERAS programs in various stages of development focused specifically on patients undergoing C-sections.

• Problem: Chronic users of opioids report their first exposure involved the use of prescription opioids. Between 0.3% and 7% of surgical patients whose first use of opioids is for post-operative pain control become persistent users. 
• Goal: Improve patient safety and satisfaction, while reducing the use of opioids after C-sections. 
• Solution: At one large private hospital in the South San Francisco Bay area, OBX maternal-fetal medicine specialists and OB/GYN hospitalists partnered with the hospital to develop an ERAS program for patients having cesarean delivery, which averages 100 patients per month. Open to all cesarean patients at the discretion of the OB provider, providers used around-the-clock acetaminophen and non-steroidal anti-inflammatory drugs (ketorolac and ibuprofen) as first-line medications to prevent pain, reserving opioids only for pain that occurred despite these medications.
• Results: In just three months after the program’s implementation, results have been promising. The number of patients participating in the program has steadily increased as familiarity with the program grows among providers. 

Before the ERAS program, the median post-operative opioid use was 130 MME (morphine milligram equivalents). For patients in the ERAS program, the opioid use was 25 MME, which is a huge reduction. Fully 30% of patients in the ERAS program used NO opioids at all during their post-operative stay. By minimizing opioid use, patients also reported feeling better overall with less grogginess or fogginess, and fewer opioid side effects such as constipation, nausea and itching.   

Similar programs have recently been rolled out in Denver, Phoenix, Seattle and Houston, with another site in Wilmington, NC, expected to launch soon. 

“We are thrilled to see these improvements in patient care and patient outcomes,” said C. Andrew Combs, MD, PhD, OBX maternal-fetal medicine specialist and Associate Director of Quality & Safety for Maternal-Fetal Medicine at MEDNAX. “We are confident that, with less use of opioids in the hospital, there will be lower risk of opioid dependence in our cesarean patients.”