Connect the Dots—July 2017

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Postdischarge Opioid Use After Cesarean Delivery
Obstet Gynecol 2017;130:36–41
Balancing concerns about over-prescribing narcotics and the real risk of prescription drug dependence with motivation to provide adequate pain relief after cesarean delivery is a challenge for doctors. In this study (see page 36) done at Vanderbilt University, a final cohort of 179 women delivered by cesarean were surveyed on postoperative day 1 and then again on postoperative day 14 about their experience of pain control; number of prescribed, used, and unused pills; and what they did with unused narcotics.1 The median duration of use of narcotics was 8 days, with 17% continuing to use them for at least 2 weeks. Women using the highest amount of narcotic at home had generally used more narcotic before discharge and were more likely to be smokers. The median number of unused tablets was 10, and of the 118 of 179 (66%) women with unused tablets, 63% kept the narcotic in an unlocked location. The authors conclude that prescribing narcotics at discharge should be individualized to avoid not only over-prescribing, which is common, but under-prescribing for a small portion of women.
As obstetrician–gynecologists, a large portion of our patients experience pain. We have a duty to adequately treat the individual in front of us by both prescribing appropriately for good pain relief and protecting her from risks of prescription drug dependence. Studies such as this one by Osmundson et al help us to develop best practices for postcesarean delivery pain control.
Nancy C. Chescheir, MD
University of North Carolina, Chapel Hill, North Carolina
1. Osmundson SS, Schornack LA, Grasch JL, Zuckerwise LC, Young JL, Richardson MG. Postdischarge opioid use after cesarean delivery. Obstet Gynecol 2017;130:36–41.
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