Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, and the Division of Obstetric Anesthesia, Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts; the Division of Obstetric Anesthesia, Center for Precision Medicine in Anesthesiology, Department of Anesthesiology, Columbia University Medical Center, New York, New York; and the Division of Pharmacoepidemiology and Pharmacoeconomics and Center for Healthcare Delivery Sciences, Department of Medicine and the Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
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OBJECTIVE:To assess whether a shared decision-making intervention decreases the quantity of oxycodone tablets prescribed after cesarean delivery.TECHNIQUE:A tablet computer-based decision aid formed the basis of a shared decision-making session to guide opioid prescribing after cesarean delivery. Women first received information on typical trajectories of pain resolution and expected opioid use after cesarean delivery and then chose the number of tablets of 5 mg oxycodone they would be prescribed up to the institutional standard prescription of 40 tablets.EXPERIENCE:From April 11, 2016, to June 10, 2016, 105 women were screened, 75 were eligible, and 51 consented to participate; one patient was excluded after enrollment as a result of prolonged hospitalization. The median number of tablets (5 mg oxycodone) women chose for their prescription was 20.0 (interquartile range 15.0–25.0), which was less than the standard 40-tablet prescription (P<.001).CONCLUSION:A shared decision-making approach to opioid prescribing after cesarean delivery was associated with approximately a 50% decrease in the number of opioids prescribed postoperatively in this cohort compared with our institutional standard prescription. This approach is a promising strategy to reduce the amount of leftover opioid medication after treatment of acute postcesarean pain.CLINICAL TRIAL REGISTRATION:ClinicalTrials.gov, NCT02770612.