MONDAY, Oct. 15, 2018 — Letting women who’ve had a cesarean section dispense and control pain medication through a catheter reduces their use of addictive oral opioid painkillers, researchers report.

Their study included 576 women who had planned C-sections. In such cases, it’s common to inject a local anesthetic and a small dose of morphine into the spinal fluid. The morphine provides about 18 hours of pain relief after surgery, but significant pain may continue for several days.

In most cases, women are given oral opioids to manage that pain.

In this study, patients had a tiny, flexible catheter inserted into their lower back as part of the anesthesia for their C-section. After surgery, it was used to deliver medication that numbs the abdomen, and women could adjust the amount of pain relief by pushing a button.

After delivery, this patient-controlled epidural analgesia (PCEA) stayed in place for a median time of 43 hours. Half of women had it less time, half had it longer.

“During the time the women studied used PCEA for their pain relief, they didn’t need oral opioids,” said lead researcher Dr. Gilbert Grant, director of obstetric anesthesia at NYU Langone Health in New York City.

The longer the women were on PCEA, the fewer opioids they needed once PCEA stopped. Each hour of PCEA led to a 0.33 mg decrease in the use of the oral opioid oxycodone, according to the study.

Twenty-five percent of the women did not use any oral opioids after their surgery. That group was on PCEA for a median time of 44.9 hours, researchers said.

Such an approach could be a step in helping to combat the U.S. opioid epidemic.

The study was to be presented Monday at the annual meeting of the American Society of Anesthesiology, in San Francisco.

While use of epidurals during labor is routine, PCEA after C-section offers a number of benefits, said Grant.

Along with reducing the need for oral opioids, PCEA results in improved movement in the intestines (which reduces constipation), and gives the mother a sense of control, Grant said in a meeting news release. The patient can continue it as long as she is in the hospital.

Research presented at meetings is typically considered preliminary until published in a peer-reviewed journal.

More information

The U.S. National Institute of Child Health and Human Development has more on cesarean section.

Posted: October 2018

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