To assess whether a shared decision-making intervention decreases the quantity of oxycodone tablets prescribed after cesarean delivery.
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.
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).
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.
A multifaceted shared decision-making intervention decreased the quantity of opioids prescribed after cesarean delivery while maintaining high levels of patient satisfaction with pain control.
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.
Corresponding author: Brian T. Bateman, MD, MSc, Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, 1620 Tremont Street, Suite 3030, Boston, MA 02120; email: BBateman@partners.org.
Continuing medical education for this article is available at http://links.lww.com/AOG/A968.
Brian T. Bateman is supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development of the National Institutes of Health (Bethesda, Maryland) under Award Number K08HD075831.
Presented at the Society for Maternal-Fetal Medicine’s 37th Annual Pregnancy Meeting, January 23–28, 2017, Las Vegas, Nevada; and at the Society for Obstetric Anesthesia and Perinatology Annual Meeting, May 10–14, 2017, Seattle, Washington.
Each author has indicated that he or she has met the journal’s requirements for authorship.
Financial Disclosure Dr. Bateman is an investigator on grants to his institution from Lilly, Pfizer, Baxalta, GSK, and Pacira. Dr. Prabhu is an investigator on a grant to her institution from Pacira. The other authors did not report any potential conflicts of interest.