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To determine clinical and sociodemographic factors influencing inpatient opioid consumption after cesarean delivery (CD) among opioid-naïve women.
We performed a retrospective cohort study of all opioid-naïve women who underwent CDs at one tertiary institution in 2015, abstracting sociodemographics, clinical characteristics, CD characteristics and inpatient postoperative consumption of all opioids. We restricted analysis to women receiving neuraxial anesthesia and neuraxial morphine. Opioid consumption was converted to oral morphine milligram equivalents (MME). Based on ACOG recommendations, we defined excess daily opioid use as >45 MME per 24 hours, excluding the first 24 postoperative hours to account for neuraxial morphine administration. We performed multivariable logistic regression to identify predictors of excess inpatient opioid use.
977 opioid-naïve women underwent CD in 2015 and met inclusion criteria. Mean and median opioid consumption were 47.3 (+22.5) and 44.0 (IQR 35.1-64.1) MME, respectively, per 24 post-operative hours. 47% exceeded the ACOG recommended post-cesarean opioid daily use. Excess opioid use was only predicted by a history of marijuana use pre-pregnancy (OR 2.86, 95% CI 1.19-6.87) (Table).
Excess inpatient opioid use after cesarean delivery is common. The primary risk factor identified is the self-reported use of marijuana pre-pregnancy. Marijuana is legalized in several states, and the full gamut of unintended consequences has yet to be described. Moreover, as increased inpatient opioid use is associated with increased outpatient use, identification of patients at risk and optimization of post cesarean pain management strategies are critical.