Analgesic use after vaginal delivery in women with perineal lacerations: a retrospective cohort study

Abstract

Objective

To evaluate opioid consumption among parturients with varying degrees of perineal lacerations.

Methods

This was a retrospective analysis of women who delivered vaginally at our institution from 1 January 2014 to 12 April 2015. We collected information regarding the degree of perineal lacerations (no lacerations, first-/second-degree, third-/fourth-degree), analgesic consumption, and postpartum pain scores. The primary outcome was opioid use from 0–48 h postpartum. Univariate and multivariable regression analyses were performed to test for the association of laceration severity with opioid use.

Results

We included 5598 women in the analysis; 1948 had no lacerations, 3434 had first-/second-degree lacerations, and 216 had third-/fourth-degree lacerations. In univariate analysis, parturients with third-/fourth-degree lacerations had significantly higher use of opioids within 48 h postpartum (53.2%) compared to women with no lacerations (30.03%) or first-/second-degree lacerations (28.6%) (p < .001). In the multivariable analysis, women with third-/fourth-degree lacerations had higher odds of opioid use than those without laceration [OR (95% CI) = 2.61 (1.75–3.85), p < .001]. In pairwise comparisons, those with third-/fourth-degree lacerations had higher odds of opioid use than those without lacerations [OR (95% CI) = 3.55 (2.20–5.74)], and those with first-/second-degree lacerations [OR (95% CI) = 2.15 (1.49–3.10)] (p < .001). Oxycodone equivalent consumption was significantly different among groups with a median (IQR) of 5.00 mg (0.00–27.50), 0.00 mg (0.00–5.00) and 0.00 mg (0.00–5.00) in women with third-/fourth-degree, first-/second-degree, and no lacerations, respectively, during the 0–48 h postpartum (p < .001).

Conclusion

The use of opioids and opioid doses are higher in women with third-/fourth-degree perineal lacerations compared to those with first-/second-degree or no lacerations.

Keywords:

• Opioids
• perineal lacerations
• pain
• vaginal delivery

Transparency

Declaration of funding

This study was supported solely by departmental funds.

Declaration of financial/other relationships

None of the authors have any relevant conflict of interest. Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

NH was involved in drafting the paper and approved the submitted version, and agree to be accountable for all aspects of the work. AL was involved in the conception and design, drafting the paper, approved the submitted version, and agree to be accountable for all aspects of the work. YJL was involved in analysis and interpretation of the data, drafting the paper, approved the submitted version, and agree to be accountable for all aspects of the work. CG was involved drafting the paper, approved the submitted version, and agree to be accountable for all aspects of the work. AH was involved in the the conception and design, analysis and interpretation of the data, drafting the paper, approved the submitted version, and agree to be accountable for all aspects of the work.

Acknowledgements

Nicole N. Hawkins was supported in part by the FAER Medical Student Anesthesia Research Fellowship (MSARF).