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Individualized Compared With Standard Postdischarge Oxycodone Prescribing After Cesarean Birth: A Randomized Controlled Trial

Osmundson, Sarah S., MD, MS; Raymond, Britany L., MD; Kook, Bradley T., MD; Lam, LeAnn, BS; Thompson, Elizabeth B., BS; Schornack, Leslie A., MD; Voorhees, Catherine E., MD; Richardson, Michael G., MD

doi: 10.1097/AOG.0000000000002782
Cesarean Delivery: Original Research: PDF Only

OBJECTIVE: To evaluate whether individualized postdischarge oxycodone prescribing guided by inpatient opioid use reduces the number of unused opioid tablets after cesarean birth.

METHODS: We conducted a randomized, controlled trial of women aged 18 years or older undergoing cesarean birth. Participants were randomized at discharge in a 1:1 ratio to a standard (30 tablets of 5 mg oxycodone) or an individualized oxycodone prescription (predicted based on each patient's inpatient opioid use). All women were contacted starting 14 days after cesarean birth to assess number of oxycodone tablets used and adequacy of pain control. The Tennessee Controlled Substance Monitoring Database was accessed to confirm dispensed opioids. The primary outcome was number of unused oxycodone tablets prescribed for pain control after cesarean birth. A total sample size of 160 women was necessary to detect a 30% difference in leftover tablets between groups with 80% power and α of 0.05.

RESULTS: Between June 14, 2017, and August 26, 2017, we screened 323 women and randomized 172. Baseline characteristics and inpatient opioid use were similar between groups. Women in the individualized group were prescribed fewer tablets (14 [interquartile range 12–16] vs 30 [interquartile range 30–30], P<.001) and had 50% fewer unused tablets than women in the standard group (5 [interquartile range 1–8] vs 10 [interquartile range 0–22], P<.001). Overall, 13% (23/172) used no opioids after discharge and 26% (44/172) used all prescribed opioids. There were no differences between the standard and individualized groups in the proportion of women who used no opioids or all opioids and no difference in the proportion of dispensed opioids used (60% [interquartile range 23–100] vs 61% [29–89], P=.93). Women in the individualized group used only half the number of prescribed opioids as women in the standard group (8 [interquartile range 4–14] vs 15 [interquartile range 6–30], P<.001). Patient-reported pain outcomes did not differ significantly by group.

CONCLUSION: Individualized opioid prescribing based on inpatient use reduces the number of unused oxycodone tablets compared with standard prescribing.

CLINICAL TRIALS REGISTRATION: ClinicalTrials.gov, NCT03168425.

Individualized prescribing after cesarean birth reduces the number of prescribed but unused oxycodone tablets.

Departments of Obstetrics and Gynecology and Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee; the University of Utah, Salt Lake City, Utah; and Vanderbilt University, Nashville, Tennessee.

Corresponding author: Sarah S. Osmundson, MD, MS, 1161 21st Avenue South, B-1118 MCN, Nashville, TN 37232; email: sarah.osmundson@vanderbilt.edu.

Dr. Osmundson was supported by K12HD043483-17 from the National Institutes of Health. This research was also supported by Clinical and Translational Science Award (CTSA) UL1TR000445 from the National Center for Advancing Translational Sciences. Biostatistical support for this project was supported by CTSA No. UL1 TR002243 from the National Center for Advancing Translational Sciences. Its contents are solely the responsibility of the authors and do not necessarily represent official views of the National Center for Advancing Translational Sciences or the National Institutes of Health.

Financial Disclosure The authors did not report any potential conflicts of interest.

Each author has indicted that he or she has met the journal's requirements for authorship.

Received March 26, 2018

Received in revised form May 16, 2018

Accepted May 24, 2018

© 2018 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.