In a retrospective analysis of cesarean deliveries from 2015 through 2020, a team of doctors from the Colorado Fetal Care Center at Children’s Hospital Colorado (Children’s Colorado) found that using a wound infusion pump in combination with enhanced recovery efforts such as removing urinary catheters earlier and walking around the same day of surgery can reduce opioid use by more than 80%. Also notable, the researchers found that a third of patients never took a single narcotic pain pill after the cesarean delivery.
“In line with our work to reduce opioid usage with the wound infusion pump, we wanted to see if enhanced recovery efforts in combination with the pump would further reduce the need for narcotic pain medicine,” said Cristina Wood, MD, co-research lead and obstetric anesthesiologist with the Colorado Fetal Care Center at Children’s Colorado. “These are moms who are going through so much already. We want to do everything we can to help them care for and interact with their baby, while providing optimum pain control.”
Cesarean delivery is one of the most common surgical procedures in the U.S., accounting for 32% of all deliveries, according to the CDC’s National Center for Health Statistics. Historically, most care providers, including those at the Colorado Fetal Care Center at Children’s Colorado, which performs a large number of cesarean deliveries for high-risk pregnancies, would use a multimodal pain management regimen including opioids.
“As concerns about the use of opioids grew and literature on the effectiveness of wound infusion pumps was inconsistent, we saw an opportunity for improvement,” said obstetrician Frank Chow, MD, co-research lead. “And the improvement was striking. Using enhanced recovery efforts such as scheduling non-narcotic medications postoperatively, limiting intraoperative IV fluids to reduce bowel swelling, implementing prophylactic anti-nausea medication, removing urinary catheters earlier and ambulating the same day of surgery in combination with the wound infusion pump resulted in a dramatic reduction in narcotic pain medication.”
In 2019, the Colorado Fetal Care Center earned the Center of Excellence designation from the Society for Obstetric Anesthesia and Perinatology. With that designation came an increased focus on enhanced recovery after cesarean.
The study, “Enhanced Recovery After Cesarean Delivery Pathway Reduces Opioid Consumption,” was presented at the Society for Maternal Fetal Medicine’s 41st Annual Pregnancy Meeting on Jan. 28, 2021.