Faith Gacheru
Pronouns: she/her
Research Mentor(s): Alex Peahl
Research Mentor School/College/Department: Dept Ob/Gyn, IHPI / Medicine
Program: UROPF
Session: Session 1 (9:00am – 9:50am)
Authors: Alex Peahl, Faith Gacheru
Abstract
Background: The receipt of opioid medications following surgery has been associated with new persistent opioid use and risk of opioid use disorder. For this reason, the gold-standard for post-operative pain includes opioid-sparing protocols, which limit opioid medications through the use of acetaminophen and Non-Steroidal Anti-Inflammatory Drugs (NSAIDs). Post-operative pain management for the 40,000 patients who undergo surgery in pregnancy each year in the United States poses unique challenges. There are limited recommendations on how maternity care professionals should balance the potential risks of opioid prescribing with the limitations of available medications in pregnancy for patients undergoing surgery. To fill this gap, we completed a systematic review to inform the development of a Clinical Practice Guideline for post-operative pain management in pregnancy. Methods: We conducted a literature review of studies describing pain management following surgery in pregnancy. We searched six databases (Ovid Medline, Scopus, Embase, PubMed, Web of Science, and Google Scholar), using terms developed in collaboration with a trained informationist. Articles were screened by two members of the study team using the PICOST (population, intervention, comparison, outcomes, setting, time) approach using Covidence software. Information on the study purpose, population, procedures, and findings were extracted, and studies were summarized. Results: In total, 1360 articles returned from initial searches. After the title and abstract screening, 86 studies were selected for full text screening, of which only 3 met inclusion criteria. Two of the three studies focused on laparoscopic surgery in comparison to open surgery. Patients who underwent laparoscopic surgery had a shorter surgery period and were prescribed opioids for a shorter period of time. Both of these studies had small sample sizes (n=21, and n=46). The third study examined predictors of receiving an opioid prescription in pregnancy and developing new persistent opioid use. Patients who underwent a procedure during pregnancy (non-delivery surgery) were more at risk of receiving an opioid prescription, but were at lower risk of new persistent opioid use. This study included a large number of participants ( n=158,425) , however the types of surgeries that were performed were not specified. Conclusions: There is sparse information in the literature describing pain management following surgery in pregnancy. Future work is needed to identify the best balance of opioid-stewardship and adequate postoperative pain control for pregnant patients. The information generated from this Systematic Review will provide support for a RAND-UCLA Appropriateness Method panel, combining the limited existing evidence and expert opinion, to develop Clinical Practice Guidelines to inform real-world clinical practice.
