(777) Effect of pannus elevation device on postoperative pain by cesarean number, timing, and gestational age

Friday, February 10, 2023

10:30 AM – 12:00 PM

Objective: Our objective was to evaluate if a pannus elevation device affects postoperative opioid use or pain scores following cesarean delivery (CD) based on cesarean characteristics, including number of CDs, timing of CD, and term versus preterm delivery.

Study Design: An initial randomized controlled trial evaluated whether a pannus elevation device affects postoperative opioid use or pain scores following CD. Patients ≥18yo were randomized to device versus no device following cesarean birth. Those with a vertical skin incision or chronic opioid use were excluded. Surveys were conducted 10 days after delivery querying remaining opioid tablets and pain scores and satisfaction. Here, we identified subgroups who may preferentially benefit from the device, by which demographic and clinical data were stratified. The primary outcome was total morphine milligram equivalents (MME) used postpartum, with secondary outcomes including subjective pain and PROMIS-29 scores. These outcomes were evaluated on the basis of primary versus repeat CD, scheduled versus unscheduled CD, and term versus preterm delivery. Wilcoxon Rank-Sum Test was used to compare outcomes, with significance defined as p < .05.

Results: All 222 patients analyzed in the original randomized controlled trial were included in this analysis. Demographic data were similar between subgroups (Table 1). Our study cohort had a 64% primary cesarean rate, with 63% of patients undergoing an unscheduled cesarean. Sixteen percent of deliveries were preterm. There were no differences in primary outcome within subgroup analyses. Significantly lower average postoperative pain score was reported in patients randomized to the device in the repeat cesarean and preterm delivery groups compared to primary and term cesarean groups, respectively (Table 2).

Conclusion: A pannus elevation device may preferentially improve patient-reported postoperative pain in certain groups undergoing cesarean birth. Larger studies are needed to confirm these findings as this study was not powered to evaluate these secondary outcomes.

Primary & Presenting Author(s)

Joseph Connor Mulhall, MD (he/him/his)
Resident
Vanderbilt University Medical Center
Nashville, Tennessee, United States

Coauthor(s)

Lisa C. Zuckerwise, MD (she/her/hers)
Assistant Professor
Vanderbilt University Medical Center
Nashville, Tennessee, United States
JT
Jennifer L. Thompson, MD
Vanderbilt University Medical Center
Nashville, Tennessee, United States
LJ
Loveis Jackson, BA
Vanderbilt University Medical Center
Nashville, Tennessee, United States
EM
Edwina McNeill-Simaan, MS
Vanderbilt University Medical Center
Nashville, Tennessee, United States
SO
Sarah S. Osmundson, MD,MSCR
Associate Professor
Vanderbilt University
Nashville, Tennessee, United States