Opioid-Sparing Multimodal Analgesia Use After Cesarean Delivery Under General Anesthesia: A Retrospective Cohort Study in 729 US Hospitals
Authors' conclusion
Variation in osMMA utilization was observed after cesarean delivery under GA in this cohort of US hospitals.
Study context
- Population
- Women over 18 years who had cesarean delivery under general anesthesia (GA), US hospitals, 2008–2018included in analysis
- Participants
- 130,946 participants
- Outcome
- Utilization of opioid-sparing MMA (osMMA): Nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen with or without opioids, without an opioid-combination drug
Methodological detailsmulticentre database (Premier Healthcare database), mixed-effects logistic regression
- Multicentre database (Premier Healthcare database)
- Mixed-effects logistic regression
Main finding
As reported in the abstract
osMMA use
osMMA used, n (%)
11,133
8.5%
osMMA use in 2008
2.0%
osMMA use in 2018
18.8%
Interhospital variability in osMMA use (intraclass correlation coefficient), moderate
38%
Observational data: associations, not effects.
Secondary outcomes
| Outcome | Values | OR (95% CI) | |
|---|---|---|---|
| osMMA use by race: Black vs White | Black 7.9% · White 9.3% | 0.87 (0.81–0.94) | |
| osMMA use by ethnicity: Hispanic vs non-Hispanic | Hispanic 8.6% · Non-Hispanic 10.0% | 0.86 (0.79–0.950) | |
| 0.512Odds ratio (log scale) |
osMMA use, preeclampsia
| Values | OR (95% CI) | ||
|---|---|---|---|
| PreeclampsiaLess likely to receive osMMA | Preeclampsia 9.0% | 0.91 (0.85–0.98) | |
| 0.512Odds ratio (log scale) |
osMMA use, history of drug abuse
| Values | OR (95% CI) | ||
|---|---|---|---|
| History of drug abuseMore likely to receive osMMA | History of drug abuse 12.5% | 1.42 (1.27–1.58) | |
| 0.512Odds ratio (log scale) |
Medical comorbidities and osMMA use
- Medical comorbidities generally not associated with receipt of osMMA
Optimal osMMA (OosMMA: local anaesthetic technique, e.g. truncal block or infiltration, plus osMMA) use
- OosMMA used, n (%)
- 2122 (1.6%)
- OosMMA use in 2008
- 0.8%
- OosMMA use in 2018
- 4.1%
Original publication
Opioid-Sparing Multimodal Analgesia Use After Cesarean Delivery Under General Anesthesia: A Retrospective Cohort Study in 729 US Hospitals. Anesth Analg. Published 22 March 2023. doi:10.
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