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Evidence-based approach to treating post-delivery pain in new moms during opioid crisis

November 14, 2017

CHICAGO - Women who undergo vaginal delivery often do not require opioids to manage pain after hospital discharge, concludes a study published in Anesthesiology, the peer-reviewed medical journal of the American Society of Anesthesiologists (ASA). In addition, the quantity of opioids prescribed to women after cesarean delivery can be less than currently prescribed. The study looked at the times it takes for pain to resolve, stopping the use of opioids and other pain medications, and functional recovery following childbirth in healthy, first-time mothers.

"Most available information about women's pain after delivery is limited to the 48 to 72 hours women are in the hospital after giving birth," said lead study author Ryu Komatsu, M.D., a physician anesthesiologist at Stanford University, California. "There are little data about what happens during the postpartum period, between the time a woman is discharged from the hospital and six weeks later when she visits her OB/GYN. We wanted to see how long it takes for the pain to resolve as well as when women regain their daily functionality."

To help provide expectations regarding pain, recovery and pain medication use for new mothers during the postpartum period, researchers studied 213 women who had given birth for the first-time. Starting the day after delivery, the women were contacted daily, either in person during their hospitalization or by telephone after discharge. They were asked about the pain on a scale of 0 to 10, painkiller use, and functional recovery.

Among women who had a vaginal delivery, 31 percent of patients required opioids for a short period in the hospital, with a median time to stopping opioid use of less than one day. Less than 10 percent required opioids after hospitalization. The median time for stopping all painkillers (including nonsteroidal anti-inflammatories and acetaminophen) was 11 days. Pain resolved in a median of 14 days.

Among women who had a cesarean delivery, 91 percent required opioids for pain management, with a median time to stopping the opioids of nine days. The median time for stopping all painkillers was 16 days, and pain resolved in a median of 21 days.

It took 47 days and 57 days for 95 percent of women undergoing vaginal delivery and cesarean delivery, respectively, to recover their normal level of daily functioning.

"Based on our observations, routine opioid prescription for new moms after vaginal delivery is not recommended, and prescription of opioids at discharge from the hospital for women undergoing cesarean delivery should be limited," the researchers concluded. "However, it is important to keep in mind that we did find significant variability in pain for both types of delivery and if opioid requirements exceed the expectations of our findings, the patients should be individually evaluated by their providers."
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THE AMERICAN SOCIETY OF ANESTHESIOLOGISTS

Founded in 1905, the American Society of Anesthesiologists (ASA) is an educational, research and scientific society with more than 52,000 members organized to raise and maintain the standards of the medical practice of anesthesiology. ASA is committed to ensuring physician anesthesiologists evaluate and supervise the medical care of patients before, during and after surgery to provide the highest quality and safest care every patient deserves.

For more information on the field of anesthesiology, visit the American Society of Anesthesiologists online at asahq.org. To learn more about the role physician anesthesiologists play in ensuring patient safety, visit asahq.org/WhenSecondsCount. Join the ANESTHESIOLOGY® social conversation today. Like ASA on Facebook; follow ASALifeline on Twitter.

American Society of Anesthesiologists

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