Utilization of Multimodal Analgesia after Cesarean Delivery with Neuraxial Anesthesia

Following Enhanced Recovery and ACOG updated Guidelines

Alana E. Davidson, BS, Matthew E. Fuller, MS, Vijay Krishnamoorthy, MD, Tetsu Ohnuma, MD, MPH, Karthik Ranghunathan, MD,

Ashraf Habib, MBBCh, MSc, MHSc, FRCA

Background

- Postoperative pain following cesarean delivery (CD) is concerning

- Opioid sparing multimodal analgesia (osMMA) is underused

- 6.1% (2008-2018)

Aims

1. Describe utilization of osMMA after CD

2. Evaluate factors associated with receipt of osMMA

Hypothesis

The utilization of osMMA increased after 2018

Study Design and Methods

Retrospective Cohort Study in Premier Database

Deliveries from 2018 - 2023

Descriptive statistics + mixed-effects logistic regression

Covariates: Patient/hospital traits, payor, location,

comorbidities

Results

• 1.6 million CDs

• Neuraxial morphine → 81.2%

• NSAIDS → 97.2%

• Plain acetaminophen → 69.8%

• Acetaminophen/opioid → 44.7%

• osMMA = 36.21%

• ↓ osMMA:

- Black, public insurance

- Medical comorbidities

- Non-teaching, rural

- < 500 beds

- Southern region

- ICC = 0.54

Conclusion & Discussion

osMMA use substantially increased

Combination drugs are still frequently used

Disparities and hospital-level variation persist