Nonopioid versus opioid analgesia after hospital discharge following cesarean delivery: a randomized equivalence trial

Abstract

Objective: To determine whether pain score after cesarean delivery is equivalent among women receiving outpatient nonopioid vs opioid analgesics.

Study design: In this trial 170 women with cesarean delivery were randomized to outpatient ibuprofen plus acetaminophen (nonopioid, n=85) or ibuprofen plus hydrocodone-acetaminophen (opioid, n=85). Primary outcome was pain score on a visual analog scale at 2-4 weeks postpartum, which was obtained from 149 (88%) women. Treatments were considered equivalent if the difference between the mean pain scores of each group and its 95% confidence interval were between -10 and 10 mm. A zero-inflated negative binomial model was used to estimate the difference between group means.

Results: Treatments were not equivalent; mean pain score was lower (better) in the nonopioid group (12.3±19.5 vs 15.9±20.4 mm, adjusted mean difference, 4.8; 95% CI, -2.1 to 11.9 mm).

Conclusion: Pain score 2-4 weeks after cesarean delivery was lower in women receiving nonopioid analgesics.

Keywords: acetaminophen; cesarean delivery; hydrocodone; ibuprofen; opioids; outpatient analgesia; postpartum care.