Oral Concurrent Session 7 - Clinical Obstetrics & Postpartum
Oral Concurrent Sessions
Hector Mendez Figueroa, MD
University of Texas Health Science Center at Houston
Houston, TX, United States
Secondary analysis of a multicenter randomized trial of individuals who had undergone CD and were randomly assigned, within 1 day prior to planned discharge to an individualized opioid prescribing plan (IOPP) or a fixed quantity of opioids upon discharge at 31 U.S. hospitals (2020-22). The primary exposure was delivery BMI. The primary outcome was inpatient oral opioid use in morphine milligram equivalents (MME) in the 24 hours prior to randomization. Secondary outcomes included outpatient opioid use calculated as number of tablets taken through 6 weeks postpartum and moderate-severe (score ≥4) perceived pain and interference in daily activities on the Brief Pain Inventory (BPI, 1-10) at 1-week postpartum. Multivariable modeling evaluated the association between BMI (with BMI < 30 kg/m2 as referent group) and opioid use and pain scores.
Results: Of 4,768 included individuals, 3,556 (74.6%) had BMI ≥ 30 m/kg2. Those with BMI ≥ 30 m/kg2 were more likely to have government assisted insurance, diabetes, and hypertension/preeclampsia, and less likely to be £ 19 years old or nulliparous. Individuals with BMI ≥ 30 m/kg2 used more opioids in the 24h prior to discharge and requested more oxycodone tablets at discharge. They used more oxycodone tablets at 1, 2 and 6 weeks post discharge, and reported a higher frequency of moderate to severe pain at baseline and at all time points assessed through 6-weeks. (Table). The association between obesity and the magnitude of pain relief did not differ by opioid use prior to discharge (p=0.56) or at the 1-week visit (p=0.45).
Conclusion: Individuals with BMI ≥ 30 m/kg2 use more opioids post-cesarean and after hospital discharge than individuals with BMI < 30 kg/m2. Despite this greater use, they demonstrate slightly poorer pain relief than subjects with BMI < 30 kg/m2.