Evidence map›Paper›PMID 26996986›Full record

ArticleAmerican journal of obstetrics and gynecology2016

Persistent opioid use following cesarean delivery: patterns and predictors among opioid-naïve women.

Brian T Bateman, Jessica M Franklin, Katsiaryna Bykov, Jerry Avorn, William H Shrank, Troyen A Brennan, Joan E Landon, James P Rathmell, Krista F Huybrechts, Michael A Fischer and 1 more

8 registry-linked trialsAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in American journal of obstetrics and gynecology, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 8 registered trials, which are not on this map. Cited by 101 papers, 7 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
101citing papers in PubMed, 7 pooled it
26.0field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT03030742 completednot on this mapstarted 2017, after this paper: background citation

Postpartum Opioid Prescribing Patterns and Patient Utilization

TypeobservationalSponsorNorthwestern UniversityRan2017 to 2019Enrolled494ConditionsPostpartum, Opioid Use, Post-operative, Cesarean DeliveryArmsSurvey
NCT03695172 phase4terminatednot on this mapstarted 2019, after this paper: background citation

Comparison of TAP, Anterior QL, or ESP Block for Elective Cesarean Section

TypeinterventionalSponsorDuke UniversityRan2019 to 2021Enrolled12ConditionsPain, Postoperative, Cesarean SectionArmsRopivacaine, TAP block, QL block, ESP block
NCT04279054 early_phase1completednot on this mapstarted 2020, after this paper: background citation

Decreased Neuraxial Morphine and Adjunctive Peripheral Nerve Blockade to Reduce Severity of Side Effects and Opioid Use After Cesarean Delivery

TypeinterventionalSponsorUniversity of Alabama at BirminghamRan2020 to 2023Enrolled87ConditionsAnesthesiaArmsMorphine Sulfate 150 mcg, Morphine Sulfate 50mcg
NCT04399707 narecruitingnot on this mapstarted 2020, after this paper: background citation

Transcutaneous Electrical Nerve Stimulation for Post-Cesarean Pain Control

TypeinterventionalSponsorHawaii Pacific HealthRan2020 to 2021Enrolled180ConditionsTranscutaneous Electric Nerve Stimulation, Analgesia, Cesarean SectionArmsTranscutaneous electrical nerve stimulation (TENS) unit, Placebo transcutaneous electrical nerve stimulation (TENS) unit
NCT04680221 phase4active not recruitingnot on this mapstarted 2021, after this paper: background citation

Stopping Opioid Overuse in Obstetrics to Halt Exposure Trial

TypeinterventionalSponsorUniversity of Missouri, Kansas CityRan2021 to 2025Enrolled97ConditionsPain, Postoperative, Opioid UseArmsLiposomal bupivacaine, TAP block, Deposition of saline
NCT06129032 naunknown statusnot on this mapstarted 2023, after this paper: background citation

Comparing Quadratus Lumborum Type 1 Block to The Combination Of Intraperitoneal Instillation Of Local Anesthetics And Wound Infiltration For Postoperative Pain After Cesarean Delivery: A Prospective Double-Blind Randomized Controlled Study

TypeinterventionalSponsorAtaturk UniversityRan2023 to 2025Enrolled40ConditionsAnalgesiaArmsWound infiltration (LWI) + Intraperitoneal local anaesthetic (IPLA) instillation, Group QUADRATUS LUMBORUM BLOCK (QLB)
NCT06434714 nawithdrawnnot on this mapstarted 2024, after this paper: background citation

Management of Postoperative Pain After Cesarean Delivery Using Bridge Auricular Percutaneous Nerve Field Stimulator

TypeinterventionalSponsorInova Health Care ServicesRan2024 to 2025Enrolled0ConditionsPost-operative Pain, Acute, Cesarean Section, Opioid Use Disorder, OpioidsArmsAuricular percutaneous nerve field stimulator, Sham auricular percutaneous nerve field stimulator
NCT07534709 phase4not yet recruitingnot on this mapstarted 2026, after this paper: background citation

Suzetrigine Versus Placebo for Opioid-Free Recovery After Cesarean Delivery: A Randomized Controlled Trial

TypeinterventionalSponsorUniversity of Texas at AustinRan2026 to 2028Enrolled90ConditionsCesarean Delivery, Cesarean Section, Pain, Postoperative, Opioid Consumption, PostoperativeArmsSuzetrigine, Placebo
3 · Its place in the literature

Who cites it

101 citing papers in PubMed, 7 syntheses or guidelines pooled it, 295 citations in OpenAlex.

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41 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors at 2 institutions in 1 country.

Brian T BatemanDivision of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Division of Obstetric Anesthesia, Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Harvard Medical School, Boston, MA. Electronic address: bbateman@partners.org.
Jessica M FranklinDivision of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
Katsiaryna BykovDivision of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
Jerry AvornDivision of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
William H ShrankCVS Health, Woonsocket, RI.
Troyen A BrennanCVS Health, Woonsocket, RI.
Joan E LandonDivision of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
James P RathmellDepartments of Anesthesia and Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
Krista F HuybrechtsDivision of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
Michael A FischerDivision of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
Niteesh K ChoudhryDivision of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
Brigham and Women's Hospital · USCVS Health (United States) · US

Funding

Comparative safety & effectiveness of antihypertensive medications in pregnancyK08HD075831 · NICHD · BRIGHAM AND WOMEN'S HOSPITAL · PI BATEMAN, BRIAN THOMAS · 2013 to 2017
$717k
NICHD NIH HHS K08 HD075831
6 · The paper itself

Abstract

backgroundThe incidence of opioid-related death in women has increased 5-fold over the past decade. For many women, their initial opioid exposure will occur in the setting of routine medical care. Approximately 1 in 3 deliveries in the United States is by cesarean, and opioids are commonly prescribed for postsurgical pain management.

objectiveThe objective of this study was to determine the risk that opioid-naïve women prescribed opioids after cesarean delivery will subsequently become consistent prescription opioid users in the year following delivery and to identify predictors for this behavior. STUDY

designWe identified women in a database of commercial insurance beneficiaries who underwent cesarean delivery and who were opioid naïve in the year prior to delivery. To identify persistent users of opioids, we used trajectory models, which group together patients with similar patterns of medication filling during follow-up, based on patterns of opioid dispensing in the year following cesarean delivery. We then constructed a multivariable logistic regression model to identify independent risk factors for membership in the persistent user group.

resultsA total of 285 of 80,127 (0.36%, 95% confidence interval, 0.32-0.40), opioid-naïve women became persistent opioid users (identified using trajectory models based on monthly patterns of opioid dispensing) following cesarean delivery. Demographics and baseline comorbidity predicted such use with moderate discrimination (c statistic = 0.73). Significant predictors included a history of cocaine abuse (risk, 7.41%; adjusted odds ratio, 6.11, 95% confidence interval, 1.03-36.31) and other illicit substance abuse (2.36%; adjusted odds ratio, 2.78, 95% confidence interval, 1.12-6.91), tobacco use (1.45%; adjusted odds ratio, 3.04, 95% confidence interval, 2.03-4.55), back pain (0.69%; adjusted odds ratio, 1.74, 95% confidence interval, 1.33-2.29), migraines (0.91%; adjusted odds ratio, 2.14, 95% confidence interval, 1.58-2.90), antidepressant use (1.34%; adjusted odds ratio, 3.19, 95% confidence interval, 2.41-4.23), and benzodiazepine use (1.99%; adjusted odds ratio, 3.72, 95% confidence interval, 2.64-5.26) in the year prior to the cesarean delivery.

conclusionA very small proportion of opioid-naïve women (approximately 1 in 300) become persistent prescription opioid users following cesarean delivery. Preexisting psychiatric comorbidity, certain pain conditions, and substance use/abuse conditions identifiable at the time of initial opioid prescribing were predictors of persistent use.

Indexed as

Cesarean SectionAdultAnalgesics, OpioidAntidepressive AgentsBack PainBenzodiazepinesDatabases, FactualDrug PrescriptionsDrug UtilizationFemaleHumansMigraine DisordersMultivariate AnalysisPostoperative PainPregnancyRisk FactorsAnalgesics, OpioidAntidepressive AgentsBenzodiazepinescesarean deliverycohortopioidspainpregnancy studies

Identifiers

PMID26996986
PMCPMC5003640
OpenAlexW2300492567

What OpenQuestion holds

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Registered trials

and 2 more above

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.