Enhanced Protocols After Surgery May Reduce Need For Opioids Following C-Section: Study

New protocols implemented after c-section surgery helped reduce pain and decreased the need for new mothers to be prescribed addictive opioid pain killers, according to the findings of new research.

In a study published late last month in the medical journal Obstetrics & Gynecology, researchers from Saint Barnabas Medical Center examined data involving women who underwent a cesarean section delivery and were treated using new protocols, which resulted in significantly fewer opioids being needed after surgery, and less time in the hospital.

Researchers studied enhanced recovery after surgery protocols (ERAS), and applied them to more than 2,100 patients undergoing c-section. Nearly 98% of patients received transverses abdomens plane blocks, or TAP blocks, in the immediate postoperative period. They were compared to patients who had c-sections in the hospital a year prior but did not receive TAP blocks.

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A TAP block is when a local anesthetic is injected deep between the internal oblique and transverse abdomens muscles reaching the nerves. It is done to help relieve pain and decrease the need for opioids.

In addition, all patients were started on scheduled multimodal analgesics, a combination of ibuprofen, acetaminophen, and dextromethorphan, until they were discharged. Patients who suffered severe pain under this combination were then given opioids for pain control.

Giving patients TAP blocks after having a c-section significantly reduced the amount of opioids patients needed. Roughly 1,770 patients needed opioids under the standard method compared to only 341 patients who had a TAP block needed opioids.

ERAS procedures have typically been used for colorectal, urological, gynecological, and hepatobiliary surgery; however, they are not widely practiced.

Researchers emphasized the need to implement the TAP procedure more widely as the opioid abuse crisis continues to worsen in the U.S.

Opioids account for nearly 70% of all overdose deaths. Doctors’ opioid prescribing patterns have largely been blamed for the opioid abuse epidemic. Research indicates some doctors are widely rewarded by drug companies to prescribe more opioids, and other studies have found that doctors prescribe powerful narcotic painkillers 30% of the time without a documented pain diagnosis.

Other studies have shown higher doses of opioids do not lessen the pain of surgery or injuries, but often increase overdose risks.

The findings of the new study indicated more than 8,000 opioid units were used before implementing ERAS protocols. After ERAS protocols were implemented 800 opioid units were used, resulting in a significant decrease in the amount of opioids patients were needing.

ERAS also helped to reduce the time to the first request for painkillers, decreased opioid related side effects like nausea and vomiting, and was more effective for pain relief.

Additionally, patients with TAP blocks spent fewer days in the hospital and the surgery and hospital stays cost them $400 less on average.

Without ERAS protocols, C-section patients are routinely given opioids around the clock and going home with a prescription for narcotic painkillers, the researchers noted. This can often lead to long-term use and sometimes abuse.


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