(273) Pain medication utilization in the obese population after implementation of multimodal pain regimen post-cesarean delivery

This was a single-institution, retrospective cohort of 907 patients who underwent CD from 01/9/22-12/31/22. A representative sample of patients from 7/2021-12/2021 was obtained for baseline comparison. A standardized pain regimen was implemented in 1/2022. Post-intervention, patients were divided into four BMI cohorts: Non-obese (BMI < 30 kg/m²), Class 1 obesity (30-34.9), Class 2 obesity (35-39.9) and Class 3 obesity (≥40). Non-opioid analgesia use was quantified over the course of the hospital stay in milligrams while opioid use was quantified in morphine milligram equivalents (MME).

Results: Of the 907 patients, 253 (28%) were non-obese, 258 (28%) were Class 1, 175 (19%) were Class 2, and 221 (24%) were Class 3. Non-obese patients were significantly younger and less likely to identify as Hispanic/LatinX than the other groups. Patients with Class 3 Obesity were more likely to deliver at an earlier gestational age, have pre-existing hypertension, diabetes and asthma, and more likely to have a combined spinal epidural for intra-operative analgesia compared to the other groups. Implementation of a standardized pain regimen decreased total median MMEs in the post-operative period from 50 to 7.5 (p< 0.0001). Post-implementation, although there were some significant differences between BMI groups related to oral acetaminophen and ibuprofen use, overall there was no difference in total MME use between BMI groups (Figure). 

Conclusion: There is no difference in post-operative opioid pain medication use in patients with higher BMIs undergoing CD in the setting of a standardized multimodal pain regimen, which provides further evidence for the use of a multimodal pain regimen in the obstetric patient population.