Contraception · 2025
Decreasing opioid provision and use while maintaining analgesia efficacy in cervical preparation with osmotic dilators before dilation and evacuation: A quality improvement initiative.
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Kendall Paige D, Sheeder Jeanelle, Fang Nancy
Аннотация
OBJECTIVES: To reduce opioid use and provision while maintaining analgesia and patient satisfaction with osmotic dilators for cervical preparation before dilation and evacuation (D&E).
STUDY DESIGN: We conducted a quality improvement initiative to reduce opioid use by studying an analgesia protocol change from the existing "routine opioid provision" to a novel "opioid-sparing" protocol. We collected data through patient surveys from patients undergoing overnight osmotic dilators before D&E from 16 to 26 weeks of gestation. We assessed pain on a numeric rating scale (0-10) before dilator placement (baseline) and D&E. The primary outcome was median change in individual pain score from baseline to maximum overnight with osmotic dilators in place.
RESULTS: Opioid provision (93.9% vs 10.3%, p < 0.001) and opioid use (57.6% vs 7.7%, p < 0.001) were lower in the novel opioid-sparing group. Median change in individual pain score was lower in the novel opioid-sparing group (7.0 [0-10]) compared to the existing routine opioid group (8.0 [0-10]) (p = 0.01).
CONCLUSIONS: The novel opioid-sparing protocol reduced opioid provision and use while also demonstrating lower pain scores and maintaining satisfaction in patients undergoing osmotic dilators before D&E.
IMPLICATIONS: Limiting opioid use for cervical preparation with osmotic dilators before second-trimester dilation and evacuation can reduce opioid provision and use, while maintaining analgesia efficacy and patient satisfaction.
STUDY DESIGN: We conducted a quality improvement initiative to reduce opioid use by studying an analgesia protocol change from the existing "routine opioid provision" to a novel "opioid-sparing" protocol. We collected data through patient surveys from patients undergoing overnight osmotic dilators before D&E from 16 to 26 weeks of gestation. We assessed pain on a numeric rating scale (0-10) before dilator placement (baseline) and D&E. The primary outcome was median change in individual pain score from baseline to maximum overnight with osmotic dilators in place.
RESULTS: Opioid provision (93.9% vs 10.3%, p < 0.001) and opioid use (57.6% vs 7.7%, p < 0.001) were lower in the novel opioid-sparing group. Median change in individual pain score was lower in the novel opioid-sparing group (7.0 [0-10]) compared to the existing routine opioid group (8.0 [0-10]) (p = 0.01).
CONCLUSIONS: The novel opioid-sparing protocol reduced opioid provision and use while also demonstrating lower pain scores and maintaining satisfaction in patients undergoing osmotic dilators before D&E.
IMPLICATIONS: Limiting opioid use for cervical preparation with osmotic dilators before second-trimester dilation and evacuation can reduce opioid provision and use, while maintaining analgesia efficacy and patient satisfaction.