Comparison of Opioid Utilization With Different Perioperative Pain Protocols After Scheduled Cesarean Delivery

Objective: Cesarean delivery pain management protocols involving pre-operative gabapentin and acetaminophen, or those specifying wound infiltration with liposomal bupivacaine, may decrease postoperative opioid utilization compared to protocols involving only neuraxial preservative-free (PF) morphine.We compared postoperative opioid consumption after scheduled cesarean deliveries among these three methods of pain management.Methods: Patients undergoing cesarean delivery with neuraxial anesthesia from January 2016 to July 2017 in our database were sorted into one of three groups: those who received gabapentin preoperatively and IV acetaminophen after fascia closure (A), those who received liposomal bupivacaine infiltrated into the wound (E), and those who received PF morphine additive as spinal or epidural anesthesia (S).Each patient's postoperative morphine equivalent units (MEUs) were calculated.Multiple regression analysis with a mixedeffects model determined the independent effects of treatment group, type of neuraxial anesthesia, age, race, surgeon, gravidity, and cesarean delivery status (primary/repeat).Results: A total of 1411 patients met the inclusion criteria.Groups differed in gravidity, race, cesarean delivery status, and anesthesia mode.Independent of those differences, MEU use differed (p <0.0001), with group A < group S < group E (all comparisons p <0.05).Conclusion: Preoperative oral gabapentin and intraoperative acetaminophen were associated with decreased perioperative opioid consumption compared to neuraxial opioids or wound infiltration with liposomal bupivacaine.This observational data warrants future similar, follow-up randomized, blinded studies.