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Operative Obstetrics

Poster Session 3

(762) Neonatal intensive care unit admission and maternal postoperative pain experience

Wednesday, February 14, 2024
8:30 AM – 10:00 AM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level

    Primary & Presenting Author(s)

  • Jennifer L. Grasch, MD

    Fellow
    The Ohio State University Wexner Medical Center
    Columbus, OH, United States

Objective: To evaluate whether there is a relationship between newborn admission to the neonatal intensive care unit (NICU) and maternal pain experience and analgesic requirements after cesarean delivery (CD).

Study Design: Secondary analysis of a multicenter randomized trial of individuals who underwent CD at 31 US hospitals (2020-22). Those whose pregnancies were complicated by major congenital anomalies, fetal or immediate neonatal death, or with missing data on the level of neonatal care required were excluded. The primary outcome was severe pain in the 24 hours prior to discharge: ≥7 on a scale from 0-10 on the Brief Pain Inventory. Secondary outcomes included assessments of opioid use and pain at defined time points. Univariable and multivariable analyses were performed.

Results:

5265 individuals (95% of parent study participants) were included in this analysis. The 1348 (25.6%) participants whose newborns were admitted to the NICU were younger, of higher BMI, more likely to self-identify as non-Hispanic Black and to have comorbidities. There was no difference in the primary outcome (54.9 vs 57.2%, aOR 0.87, 95% CI 0.75-1.00) or rates of severe pain at 1 (Table), 2, 6 weeks, or 90 days postoperatively between the two groups (data not shown). Rates of moderate pain (≥4) at enrollment (88.1 vs 90.4%, aOR 0.70, 95% CI 0.57-0.88) and 1 week postpartum (57.5 vs 60.9%, aOR 0.81, 95% CI 0.70-0.94) were lower for people with infants in NICU.

Despite similar pain scores, people with infants in NICU had higher average daily and total postoperative inpatient opioid use (adjusted median difference 13.2 morphine milligram equivalents, 95% CI 7.8-18.7; Table).

Conclusion: In the postoperative period, parents whose infants were admitted to the NICU required higher doses of opioids to achieve similar pain control after CD.