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For people undergoing cesarean
delivery, an inadvertent consequence of provider opioid prescribing patterns
was reported in the immediate post-ERAS implementation period.
In a retrospective observational quasi-experimental study, implementation of Enhanced recovery after surgery (ERAS) decreased the overall percentage of people receiving a discharge opioid prescription following cesarean delivery. However, for a subset of people receiving an opioid prescription, implementing ERAS might have unintentionally elevated the prescribing of daily doses >90 oral morphine equivalents (OME).
E. M. Langnas et al. aimed to examine the link between ERAS implementation and discharge opioid prescribing patterns in 2249 opioid-naïve people aged 18+ and undergoing cesarean delivery. For accounting for the pre-existing temporal trends, an interrupted time series analysis was utilized for modelling the alterations in pain medication prescribing linked with ERAS implementation. Out of 1473/2249 people who underwent cesarean delivery following ERAS implementation, 80.72% received a discharge opioid prescription when compared to 95.36% at the baseline.
The pre-ERAS daily OME on the discharge prescription dropped by 0.48 OME each month. A level shift of thirty-five more OME prescriptions was noted. This was followed by a monthly decline of 1.4 OMEs per month following the implementation of ERAS. In people who were given a prescription, 61.35% were given a total daily dose > 90 OME in comparison with 11.35% pre-implementation. Following the implementation of ERAS, the prescriptions with a total daily dose of < 50 OME reduced from 79.86 to 25.85%.
While implementing ERAS resulted in
an increase in multimodal analgesia and opioid-free pain control in the last 24
hours before discharge, a considerable rise in the daily OME written on the
discharge opioid prescription was also noted. Thus, the findings of this
interrupted time series analysis emphasize the significance of early and
continued assessment following implementation of novel policies which are
intended to minimize the risk of opioid exposure in selected patients.
Perioperative Medicine
Enhanced recovery after surgery protocol and postoperative opioid prescribing for cesarean delivery: an interrupted time series analysis
E. M. Langnas et al.
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