OPIATE-SPARING ANALGESIA PROTOCOL FOR PAIN AFTER OSMOTIC DILATOR PLACEMENT: A QUALITY IMPROVEMENT STUDY

Objectives

We aimed to compare maximum overnight pain scores and patient satisfaction with routine opiate provision versus an opiate-sparing analgesia protocol after osmotic dilator placement before dilation and evacuation.

Methods

We conducted a quality improvement study comparing out-of-clinic analgesia protocols for patients undergoing one and two days of osmotic dilator cervical preparation prior to dilation and evacuation at 16 to 26 weeks gestation. For two 13-week periods, we assessed the outcomes of our previous analgesia protocol of universal opiate prescription to our new protocol in which we only provided an opiate prescription at patient request or provider recommendation. Pain was assessed using an 11-point numerical rating scale (NRS; scale 0-10). The primary outcome was median individual pain score change from baseline to maximum. Patient and clinical characteristics, anxiety, sleep, activity disruptions, analgesic use, and patient satisfaction were assessed by medical record review and patient surveys.

Results

The routine opiate provision and opiate-sparing groups included 55 and 50 patients, respectively. 52 (92.9%) in the routine opiate provision group and 7 (14%) in the opiate sparing protocol received an opiate prescription (p=<0.001). For patients undergoing one and two days of osmotic dilators, the median change in pain from baseline to maximum did not differ between groups (7.0 (range:0-10) to 6.0 (0-10);p=0.06 and 8.0 (0-10) to 6.0 (5-10);p=0.45). Anxiety, satisfaction, other analgesic use, calls to providers, and complications did not differ between groups.

Conclusions

Clinicians can utilize an opiate-sparing protocol for analgesia after osmotic dilator placement to reduce opiate prescriptions while providing adequate analgesia and satisfaction.