Decreasing opioid provision and use while maintaining analgesia efficacy in cervical preparation with osmotic dilators before dilation and evacuation: A quality improvement initiative

Abstract

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.