Dr . Chow says the team initiated the study to demonstrate objectively that the addition of the wound infusion pump after cesarean delivery would decrease postoperative narcotic use by new moms .
“ We saw approximately a 30 % reduction in narcotic usage as a result ( 1 ),” he says . “ A bonus finding was that the patients were happier because they were moving around better and had an easier time visiting their babies in the neonatal and cardiac intensive care unit .”
The Colorado Fetal Care Center has since universally implemented the pump as part of its multimodal postoperative pain management strategy for all cesarean deliveries .
ENHANCED RECOVERY PLUS THE PUMPS
In 2019 , the Colorado Fetal Care Center earned the Center of Excellence designation from the Society for Obstetric Anesthesia and Perinatology . With that designation came a focus on enhanced recovery after cesarean , or ERAC .
Nationally recommended protocols for ERAC include directives like scheduling non-narcotic medications postoperatively , limiting intraoperative IV fluids to reduce bowel swelling , implementing prophylactic anti-emetic medication , removing urinary catheters earlier and ambulating the same day of surgery .
“ It was a huge protocol we rolled out in January 2020 ,” says Dr . Wood . “ And in line with our work related to the reduction of opioid usage with the wound infusion pump , we certainly wanted to see if these enhanced recovery efforts in combination with the pump would drop that 30 % reduction even further .”
It did . A retrospective analysis of cesarean deliveries at the Colorado Fetal Care Center from 2015 through 2020 found that there was more than an 80 % reduction in postoperative narcotic usage when wound pumps were incorporated with the ERAC protocol . Also notable , the researchers found that a third of patients never took a single narcotic pain pill after the cesarean delivery .
“ These findings show an impressive decrease in opiate use after cesarean delivery ,” says Dr . Chow , “ and have significantly contributed to postoperative pain management and patient satisfaction at Children ’ s Colorado .” •
Pediatric anesthesiologist Melissa Masaracchia , MD , presented the study “ Enhanced Recovery After Cesarean Delivery Pathway Reduces Opioid Consumption ” at the Society for Maternal Fetal Medicine ’ s 41st Annual Pregnancy Meeting on January 28 , 2021 .
1 . Michael Zaretsky , Cristina Wood , Traci Nivens , Gerald McLaughlin , Jeannie Zuk , Zhaoxing Pan & Franklin Chow . 2019 . Continuous local bupivacaine wound infusion with neuraxial morphine reduces opioid consumption after cesarean delivery . The Journal of Maternal Fetal & Neonatal Medicine . 32:23 , 3895-3902
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