Improving opioid use at induction of general anaesthesia in obstetric patients in a large tertiary centre.
N. Toner, S. Harbison, J. Critchley, N. Alexander, K. Theodosiou
1 South East Scotland School of Anaesthesia, 2 Simpson Centre for Reproductive Health, Royal Infirmary of Edinburgh, NHS Lothian, UK
Background
oAdministration of opioid medication at induction of general anaesthesia (GA) in obstetrics is safe and beneficial.
oReluctance is associated with concerns about neonatal ill-effects.
oA systematic review with meta-analysis demonstrated no association between rapid-acting opioids use and poorer Apgar scores1.
oRoutine use of opioids at induction is the intended standard of care in our high-volume tertiary obstetric unit.
oHowever despite an increase in adherence from 40% in 2022 to 62% in 2023, the potential for further improvement remains.
Objective
oTo improve adherence to the local departmental guideline:
oOpioid medication should be used at induction in all obstetric GA cases (unless contraindicated).
Data Collection
oData were collected prospectively from Jan 2023 - Sep 2024 (21 months) from the continuous department audit activity.
oProcedural data were recorded by the case anaesthetists.
oThe project was registered with the local Clinical Governance team and Caldicott approval was granted.
QI Interventions
Workplace Interventions
oMultimodal improvement interventions encouraged opioid use provided evidence-based rationale for their use:
•Visual: Posters in obstetric anaesthetic rooms
•Practical: Pre-labelled opioid syringe with induction drugs
•Oral: Reminder at daily Safety Brief
Educational Interventions
oA component was introduced into the departmental Tea Trolley Teaching educational programme.
oThis provided orientation to our bespoke Intubation Checklist, highlighting the opioid care standard.
oDelivered to regular / non-regular anaesthetic staff
Data pertaining to anaesthetic practice were available for
238/281 (85%) in 2023 vs 241/267 (90%) in 2024
Adherence – All obstetric GA cases
Opioid use at induction for all obstetric GA cases: 149/238 (67%) in 2023 vs 187/241 (78%) in 2024 (p <0.001)
Adherence – GA Caesarean sections
Opioid use at induction for GA Caesarean cases: 67/144 (46.5%) in 2023 vs 112/160 (70%) in 2024 (p <0.001)
Discussion
oNeonatal ill effects are likely to be overstated, especially in the context of newer short-acting opioids.
oThere was an increase in opioid use, which is likely attributable to the practical and educational interventions in this QIP.
oFurther work will:
oDevelop the educational programme
oIncrease support for transient anaesthetic team members
oMonitor opioid use as part of the ongoing audit of practice.
References
White LD, Hodsdon A, An GH, et al. Induction opioids for caesarean section under general anaesthesia: a systematic review and meta-analysis of randomised controlled trials. International Journal of Obstetric Anesthesia 2019; 40: 4–13
