Interventions to Reduce Inpatient and Discharge Opioid Prescribing for Postpartum Patients: A Systematic Review.
Nevert Badreldin, Julia D Ditosto, Kai Holder and 2 others
PMID 36811227WHAT IT FOUND
Scheduled non-opioid pain plans, reduced discharge opioid prescribing, and shared decision-making lowered postpartum opioid use.
Abdominal binders, lidocaine patches, valdecoxib, and acupuncture showed no reduction.
Key findings
01Inpatient multimodal stepwise protocols with scheduled ibuprofen and acetaminophen, and single changes in dosing or timing, decreased the proportion of patients receiving opioids and the amount used.
02Enhanced counseling and shared decision-making reduced discharge opioid prescribing or consumption, and eliminating routine discharge opioid prescriptions reduced opioids prescribed and consumed.
03Abdominal binders, lidocaine patches, valdecoxib, and battlefield acupuncture did not show a reduction in opioid use; one abdominal binder trial reported no difference in morphine milligram equivalents on postoperative day 1 (21.1 vs 23.8) or day 2 (28.4 vs 28.1).
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The review combined very different interventions and outcomes, so it could not pool results or identify one best intervention. Most included studies were retrospective cohorts, so pre- and post-intervention differences could reflect changing awareness of the opioid epidemic rather than the intervention alone. Many studies had moderate GRADE and fair internal validity, largely because participants, researchers, outcome assessors, or outcome measures were not blinded. The review excluded non-English studies and studies outside the United States. It focused on opioid-related outcomes and did not include patient-centered outcomes such as satisfaction, provider acceptability, health equity, or recovery experience.
Declared interests
The authors declared no conflicts of interest.
The easy way to misread this
Do not read this as proof that one postpartum opioid protocol is best for every patient. The review combined very different interventions, mostly retrospective studies, and could not identify a single optimal approach; some adjuncts did not reduce opioid use.