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Cesarean birth, Maternal health services, Morphine derivatives, Opioid-related disorders, Pain management, Postpartum period



  1. Harden, Ronda DNP, MSN, RNC-MNN, PHN, CLEC
  2. Dawkins, Denise DNP, RN, CNL, CHSE
  3. Stallings-Saints, Keya MSN, RNC-OB, C-EFM, CNML
  4. Hampton, Michelle DeCoux PhD, MS, RN
  5. DeLilly, Carol PhD, MSN, PHN, RN


Purpose: To evaluate the impact of implementing a multimodal plan of care in treating the pain of the postoperative cesarean birth patient that limited opioid exposure.


Study Design and Methods: A retrospective medical record review was conducted to evaluate a pain management protocol implemented for postoperative cesarean patients before and after a practice change. Sample included term postoperative cesarean patients >= 37 weeks of gestation, who had spinal or epidural, were 18 years or older, gave birth to a singleton newborn, admitted to the maternal child health department, and were prescribed opioids as a postoperative pain management treatment plan. Participants (N = 150) were evaluated based on two groups: n = 75 in the preimplementation group and n = 75 in the postimplementation group.


Results: There was a significant difference in the total oral opioid milligrams administered between the pregroup (M = 27.13) and postgroup (M = 8.43), after the practice change (p < .001). There was an increase of nonopioids administered to treat and manage postoperative cesarean pain, Motrin PO (p = < .001) and Tylenol PO (p = .002).


Clinical Implications: Fewer milligram equivalents of morphine were administered when postoperative cesarean patients were placed on scheduled nonopioids to treat pain.