scholarly journals Factors Associated With Postoperative Opioid Prescribing After Primary Elective Cesarean Section

2021 ◽  
Author(s):  
Michael S Patzkowski ◽  
Kevin L Hammond ◽  
Germaine Herrera ◽  
Krista B Highland
Keyword(s):  
Pain Management ◽  
Cesarean Section ◽  
Medical Center ◽  
Elective Cesarean Section ◽  
Adult Women ◽  
Electronic Health Record Data ◽  
Present Sample ◽  
Factors Associated ◽  
Opioid Prescribing ◽  
Medical Factors

ABSTRACT Introduction Guidelines indicate the need to balance the risks of opioid prescribing with the need to adequately manage pain after cesarean section (CS). Although guidelines suggest the need for tailored opioid prescribing, it is unclear whether providers currently tailor opioid prescribing practices given patient-related factors. Thus, research is needed to first understand post-CS pain management and opioid prescribing. The objective of the present study was to identify factors related to CS discharge opioid prescriptions. Material and Methods This retrospective cohort study was approved by the Brooke Army Medical Center Institutional Review Board (San Antonio, Texas; #C.2020.094e) on June 23, 2020. Electronic health record data of healthy adult women undergoing primary elective CS, performed under regional neuraxial anesthesia at a single, academic, tertiary medical center from 2018 to 2019, were included. Multivariable regression examined patient and medical factors associated with post-CS opioid prescriptions. Results In the present sample (N = 169), 23% (n = 39) of patients did not use opioids postoperatively, while inpatient and almost all of those patients (n = 36) received a discharge prescription for opioids with a median amount of 225 morphine milligram equivalent doses. There was a lack of evidence indicating that patient and medical factors were associated with discharge opioid dose. Conclusion Patient and medical factors were not associated with post-CS opioid prescribing. Larger studies are needed to better elucidate optimal post-CS pain management in the days and months that follow CS. Such findings are needed to better tailor opioid prescribing, consistent with clinical practice guidelines.

scholarly journals Disparities in Pediatric Patient Portal Activation and Feature Use

JAMIA Open ◽  
2021 ◽  
Vol 4 (3) ◽  
Author(s):  
Jennifer H LeLaurin ◽  
Oliver T Nguyen ◽  
Lindsay A Thompson ◽  
Jaclyn Hall ◽  
Jiang Bian ◽  
...  
Keyword(s):  
Medical Center ◽  
Academic Medical Center ◽  
White Female ◽  
Patient Portal ◽  
Patient Portals ◽  
Electronic Health Record Data ◽  
Factors Associated ◽  
Academic Medical ◽  
Vulnerable Individual ◽  
Records Access

Abstract Objective Disparities in adult patient portal adoption are well-documented; however, less is known about disparities in portal adoption in pediatrics. This study examines the prevalence and factors associated with patient portal activation and the use of specific portal features in general pediatrics. Materials and methods We analyzed electronic health record data from 2012 to 2020 in a large academic medical center that offers both parent and adolescent portals. We summarized portal activation and use of select portal features (messaging, records access and management, appointment management, visit/admissions summaries, and interactive feature use). We used logistic regression to model factors associated with patient portal activation among all patients along with feature use and frequent feature use among ever users (ie, ≥1 portal use). Results Among 52 713 unique patients, 39% had activated the patient portal, including 36% of patients aged 0–11, 41% of patients aged 12–17, and 62% of patients aged 18–21 years. Among activated accounts, ever use of specific features ranged from 28% for visit/admission summaries to 92% for records access and management. Adjusted analyses showed patients with activated accounts were more likely to be adolescents or young adults, white, female, privately insured, and less socioeconomically vulnerable. Individual feature use among ever users generally followed the same pattern. Conclusions Our findings demonstrate that important disparities persist in portal adoption in pediatric populations, highlighting the need for strategies to promote equitable access to patient portals.

scholarly journals DECREASE PRESCRIBING OF POSTOPERATIVE OPIOIDS IN PEDIATRIC ACL RECONSTRUCTION- TREATMENT TRENDS AT A SINGLE CENTER

2021 ◽  
Vol 9 (7_suppl3) ◽  
pp. 2325967121S0006
Author(s):  
Ajith Malige ◽  
Joshua T. Bram ◽  
Kathleen J. Maguire ◽  
Lia W. McNeely ◽  
Theodore J. Ganley ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Pain Management ◽  
Acl Reconstruction ◽  
Pain Control ◽  
Unique Challenge ◽  
Opioid Medication ◽  
Factors Associated ◽  
Opioid Prescribing ◽  
Medication Prescribing ◽  
Opioid Medications

Background: Pain control following ACL Reconstruction (ACLR) presents a unique challenge due to age and early rehabilitation needs. Significant efforts have been made to reduce unnecessary opioid prescribing in this vulnerable population, but few have sought to define current practices. Purpose: The purpose of this study is to describe trends in postoperative pain management and assess factors that may mitigate overutilization of opioid medications. Methods: This is a retrospective review of a series of pediatric patients (<18yo) undergoing primary ACLR within an urban academic hospital system over a 5-year period (2014-2018). The period included the gradual introduction of preoperative consenting for opioid use in minors as mandated by state law in 2016. Patient demographics, surgical details, presence of opioid consent, prescribed postoperative medications, prescriber, and indicators of inadequate pain control were collected. Trends in medication prescribing were assessed. Univariate and multivariate analyses were performed to identify factors associated with reduced postoperative opioid prescribing. Results: This study included 687 patients with a mean age of 15.1±1.9 years. The majority underwent ACL reconstruction using hamstring autograft (92.0%) at our main hospital (54.9%). Postoperatively, discharge medication prescribing was performed most frequently (38.1%) by advanced practitioners (NP/PA). While there was no change in the proportion of patients prescribed opioids (>95% of patients) over the 5 year period, the mean number of doses dispensed decreased annually (Fig. 1). This was accompanied by an increase in the annual percentage of patients prescribed oral NSAIDs and acetaminophen during that period. Preoperative opioid consent was obtained in 31.9% of the cohort and these patients received significantly fewer doses of prescribed opioids (25.0 vs. 34.6 doses, p<0.001), while still having a lower rate of uncontrolled pain prompting early unplanned contact via telephone, ED or clinic. Preoperative consenting (IRR 0.764, CI 0.634-0.920, p=0.005) and satellite surgical location (IRR 0.712, CI 0.517-0.979, p=0.037) were identified as significant predictors of decreased number of postoperative opioid doses prescribed following multivariate regression analysis (Table 2). Conclusion: Total doses of postoperative opioids prescribed for pain management in pediatric ACLR have declined in recent years, which appears related to preoperative counseling through mandated opioid consenting and paralleled by greater utilization of non-opioid medications. Continued efforts should be made to identify measures to limit overreliance on these medications and to mitigate issues related to misuse, overdose and addiction. [Figure: see text] Annual proportion of patients prescribed ibuprofen, acetaminophen and opioid medication postoperatively and the annual mean number of opioid doses prescribed. [Table: see text] Univariate and multivariate negative binomial regression analysis of factors associated with prescription of a greater number of postoperative doses of opioid medication. CI = Confidence Interval.

scholarly journals Factors associated with cesarean delivery in adult nulliparous women

2021 ◽  
Vol 43 ◽  
pp. e53083
Author(s):  
Maria Cristina Antunes Willemann ◽  
Célia Adriana Nicolotti ◽  
Tatiane Baratieri ◽  
Emil Kupek
Keyword(s):  
Cesarean Section ◽  
Sociodemographic Factors ◽  
P Value ◽  
Adult Women ◽  
Normal Delivery ◽  
Factors Associated ◽  
Nulliparous Women ◽  
Favorable Conditions ◽  
Prenatal Visits ◽  
Years Of Schooling

The aim of this study was to analyze the sociodemographic factors associated with cesarean section in adult women with conditions favorable for normal delivery and to identify the groups most likely to undergo this surgery in the state of Santa Catarina (SC). A case control study with microdata from the Sistema de Informação de Nascidos Vivos on 7,065 women for 2016 in SC. A relationship between cesarean section and sociodemographic variables was analyzed by logistic regression where we calculated the Adjusted Odds Ratio (AOR), confidence interval and p-value. The probability of cesarean section for each group of women (called "interaction") was also calculated. Among women with more favorable conditions for normal childbirth, the prevalence of cesarean section was 41.1%. Lower chance of cesarean section was found for women without partners (AOR: 0.79 [0.71-0.87]), up to 8 years of schooling (AOR: 0.56 [0.47-0.66]), with up to 2 prenatal visits (AOR: 0.46 [0.23-0.90]). The most likely group of women (51.4% [49.3-53.4]) to undergo cesarean section are women who perform 7 to 15 prenatal visits and have 12 or more years of schooling. A cesarean section occurs with women who have greater access to education and prenatal care and those who have partners, even though the aspects favor normal childbirth, suggesting that this does not seem to be a decision only by women.

scholarly journals Incidence of Hypotension and Associated-risk Factors in Epidural Anesthesia With 2% Lidocaine and Epinephrine During Elective Cesarean Section, Efficacy and Safety Assessment

2021 ◽  
pp. 9
Author(s):  
Keyword(s):  
Blood Pressure ◽  
Cesarean Section ◽  
Systolic Blood Pressure ◽  
Epidural Anesthesia ◽  
Gestational Age ◽  
Elective Cesarean Section ◽  
Efficacy And Safety ◽  
Factors Associated ◽  
Baseline Systolic Blood Pressure ◽  
Elective Cesarean

Background: Cesarean section is a worldwide common surgery that requires anesthetic techniques. Many local anesthetics are being now used, but are associated with, dose- dependent and at different level, some side effects including toxicity. Hypotension was described as the first and threat side effect associated to neuraxial techniques. Despite many preventive strategies, it continues to challenge anesthesia providers around the world. Lidocaine was found to be less toxic compared with others commonly used and has been recommended for anesthesia procedures requiring large dose of local anesthetic including epidural anesthesia. The main purpose of this research was to determine the incidence of hypotension and identify the possible risk factors associated with it and thus, assess the efficacy and safety when lidocaine is applied together with epinephrine, in epidural anesthesia for elective cesarean delivery. Materials and methods: This retrospective observational institutional-based study, recruited 612 parturients who underwent elective cesarean section under epidural anesthesia with 2% lidocaine and 1/200000 epinephrine, at 1st affiliated hospital of Chongqing Medical University in 2019. Exclusion criteria included any contraindication to elective cesarean section delivery, general anesthesia, baseline systolic blood pressure < 100mmh and > 140 mm hg, gestational age < 37 weeks and > 42 weeks etc. SPSS 26.0 version and different appropriated tests were used for statistical analysis. P value < 0.05 was accepted as statistically significant. Results: The hypotension incidence was 13.2%, and identified factors associated with it were Baseline Systolic Blood Pressure < 120mmhg, gestational age < 40 weeks, maternal body weight ≤ 60 kg and duration of cesarean delivery (surgery) > 45 minutes. Conclusion: The variables in correlation with increased hypotension rate are baseline systolic blood pressure, gestational age, maternal weight, and surgery duration. 2%Lidocaine with epinephrine as adjuvant presented best outcomes towards both mother and neonates, was therefore efficacy and safe under the anesthetic conditions of our study.

scholarly journals Comparison of Tramadol Versus Tramadol and Paracetamol in Postop Pain Management after C-Section

2021 ◽  
Vol 15 (5) ◽  
pp. 1035-1037
Author(s):  
Usman Salamat ◽  
M.Baqir Ali Khan ◽  
Liaqat Ali ◽  
Tahir Nazeer ◽  
Amna Tahir ◽  
...  
Keyword(s):  
Body Weight ◽  
Pain Management ◽  
Cesarean Section ◽  
Pain Control ◽  
Elective Cesarean Section ◽  
Post Surgery ◽  
Postop Pain ◽  
Elective Cesarean ◽  
Group A ◽  
Group B

Background: Multimodal technique of pain control is better than unimodal technique in perioperative time. Both tramadol and paracetamol are commonly used for pain control. Aim: To compare the tramadol alone versus tramadol with paracetamol in pain management after C- section. Method: 150 patients with ASA class P1&P2 undergoing elective cesarean section under general anesthesia were included in this study and were divided into group A & B by random number table. In both group tramadol 1mg/kg body weight intravenous was given after delivery of baby and in group B intravenous paracetamol 15 mg/kg body weight was given additionally and same doses were given in postop after 8 hours for 24 hs of post-surgery. Result: Mean age in group A was 31.04±5.35 years and in group B it was 29.64±5.92. Mean pain score in group A was 1.19±0.81 and in group B it was 0.60±0.75. The degree of pain was low in group B and patients were more comfortable as compared to group A patients. Conclusion: Tramadol plus paracetamol has better pain control as compared to tramadol alone. Keywords: Tramadol, Paracetamol, Cesarean Section, VAS.

scholarly journals Lack of Influence by CYP3A4 and CYP3A5 Genotypes on Pain Relief by Hydrocodone in Postoperative Cesarean Section Pain Management

2019 ◽  
Vol 3 (6) ◽  
pp. 954-964 ◽  
Author(s):  
Keivan Hosseinnejad ◽  
Tyler Yin ◽  
Jeremy T Gaskins ◽  
M Elaine Stauble ◽  
Yanhong Wu ◽  
...  
Keyword(s):  
Pain Management ◽  
Side Effects ◽  
Pain Relief ◽  
Cesarean Section ◽  
Multivariate Regression ◽  
Statistical Significance ◽  
Individual Response ◽  
Multivariate Regression Model ◽  
Anova Analysis ◽  
Factors Associated

Abstract Background Genetic polymorphisms of cytochrome P450 are contributors to variability in individual response to drugs. Within the P450 family, CYP2D6 is responsible for metabolizing hydrocodone, a widely prescribed opioid for pain management. Alternatively, CYP3A4 and CYP3A5 can form norhydrocodone and dihydrocodeine. We have previously found that in a postcesarean section cohort, the rate of hydromorphone formation was dependent on the genotype of CYP2D6 and that plasma hydromorphone, not hydrocodone, was predictive of pain relief. Method Blood was obtained from a postcesarean cohort that were surveyed for pain response and common side effects. Plasma samples were genotyped for CYP3A4/5, and their hydrocodone concentrations were measured by LC-MS. R statistical software was used to check for differences in the outcomes due to CYP3A4/5 and CYP2D6, and a multivariate regression model was fit to determine factors associated with pain score. Results Two-way ANOVA between CYP3A4/A5 and CYP2D6 phenotypes revealed that the former variants did not have a statistical significance on the outcomes, and only CYP2D6 phenotypes had a significant effect on total dosage (P = 0.041). Furthermore, a 3-way ANOVA analysis showed that CYP2D6 (P = 0.036) had a predictive effect on plasma hydromorphone concentrations, and CYP3A4/A5 did not have any effect on the measured outcomes. Conclusions With respect to total dosages in a cesarean section population, these results confirm that CYP2D6 phenotypes are predictors for plasma hydromorphone concentration and pain relief, but CYP3A4/A5 phenotypes have no influence on pain relief or on side effects.

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