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Scheduled Non-Opioid Medications for Postpartum Pain Management in Individuals Receiving Medications for Opioid Use Disorder

Resident: Leah Skaggs, MD

Faculty Advisor: Stephanie Pierce, MD


Medication for opioid use disorder (MOUD) is currently the standard of care for people with opioid use disorder (OUD) during pregnancy. Thus, pain control during the postpartum period is an important issue. However, few studies have examined pain regimens for postpartum people with OUD.


We performed a retrospective cohort study of patients age 18-49, receiving treatment with MOUD, and who delivered at our institution from 1/1/2012-4/1/2021. Using manual chart review, we calculated the total morphine equivalent dosage (MED) received by each patient during the postpartum hospital stay, excluding dosage from MOUD. The primary outcome was total dose of additional oral opioids received during the postpartum hospital stay in MED in patients who underwent cesarean delivery and received scheduled oral non-opioid pain medications (acetaminophen and ibuprofen) postpartum vs those who did not. Associations were estimated using Fisher’s exact, Wilcoxon rank sum, modified Poisson regression, and negative binomial regression.


Of 173 patients, 64 had a cesarean (Table 1). Of those, most patients required additional opioid medications (beyond their MOUD dose), regardless of whether they received scheduled non-opioid medications or not (82.6% in the scheduled group vs 82.9% in the non-scheduled group, p=1.00; Table 2). The scheduled group received a numerically lower median dose of additional opioids (87.0 MED [8.0, 210.0] vs 135.0 MED [30.0, 213.7]; p=0.30). After adjustment for MOUD dose at delivery admission, gabapentin use, and year of delivery, the total dose of additional opioids received during the postpartum hospitalization was similar in women who received scheduled non-opioid medications compared to those who did not (incidence rate ratio 1.07; 95% CI: 0.46, 2.48).


In patients on MOUD who underwent cesarean delivery, total dose of additional opioids needed for pain control during the delivery hospitalization was similar between those who received scheduled non-opioid medications and those who did not. Further research is needed regarding optimal pain management strategies in postpartum patients on MOUD.

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