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26 Racial disparities in post-operative pain experience and treatment following cesarean birth

      Objective

      To evaluate racial/ethnic differences in post-operative pain experience and opioid medication use (morphine mg equivalent (MME)) in the first 24 hours following cesarean birth.

      Study Design

      This was a retrospective cohort study of women who underwent cesarean delivery at Meriter Hospital in Madison, WI between 01/01/2016 and 12/31/2017. A total of 2228 opioid-naive women were included. Pain assessment utilized all recorded pain scores (assessed on a 0-10 scale) in the first 24 hours post-delivery, which were abstracted manually. Linear regression was used to analyze the impact of race/ethnicity on pain and MME use.

      Results

      In multi-variate analysis non-Hispanic (NH) Black women reported higher average pain scores (coefficient: 0.629, 95% CI [0.414-0.844], p<0.001) (Table 1) than NH White women, but received similar quantities of MME (coefficient: 0.13 mg, 95% CI [-5.12-5.38], p=0.961) (Table 2). NH Asian women had similar reported average pain scores to NH White women (coefficient: -0.02, 95% CI [-0.218-0.179], p=0.845) (Table 1), but received less MME (coefficient: -7.44 mg 95% CI [-12.28- -2.59], p=0.003) (Table 2).

      Conclusion

      Despite reporting higher average pain scores, NH Black women did not receive higher quantities of MME. NH Asian women received lower quantities of MME despite reporting similar pain scores to NH White women. These differences suggest disparities in post-operative pain management for women in these minority populations. Further investigation into patient perspectives on pain management in the postpartum period and strategies for interventions to reduce these disparities are warranted.
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