1. Potera, Carol


Shared decision making cuts the number of pills prescribed.


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Cesarean sections are the most common inpatient surgical procedures in the United States, with 1.3 million performed yearly. Opioids, primarily oxycodone, are prescribed after cesareans to control pain. Two new studies suggest, however, that opioids following cesarean sections may be excessively prescribed.


A survey of 720 women who underwent cesarean deliveries at six medical centers in the United States found that although an average of 40 opioid pills were prescribed, the women's average use was only 20 pills, and most had not disposed of their extra pills two weeks after hospital discharge. Moreover, women prescribed higher numbers of pills took more opioids, suggesting that the number of pills prescribed may influence how many patients take. Notably in this study, the number of opioid pills prescribed did not correlate with improved pain scores.


In a second study, 50 women shared in the decision about how many opioid pills to take home. They learned about pain patterns two weeks after cesarean delivery, the risks and benefits of opioids and other pain medications, and safe opioid disposal. Then the women were asked to select 40 or fewer oxycodone pills (5 mg) at discharge. This process cut the number of opioids requested by patients to 20 pills, compared with the typical 40-tablet prescription. On average, the women used only 16 opioid pills in the first two weeks after discharge.


"Since our study, patients are routinely discharged with 25 opioid pills," study leader Malavika Prabhu told AJN. Ibuprofen and acetaminophen are also prescribed for inpatients and outpatients unless contraindicated. Prabhu noted the importance of nurses as partners in educating patients on the daily tapering of opioid use after discharge and proper disposal of leftover pills to guard against misuse.-Carol Potera




Bateman BT, et al Obstet Gynecol 2017;130(1):29-35; Prabhu M, et al Obstet Gynecol 2017 130 1 42-6