(302) Race/ethnicity differences in peripartum pain management

The objective of this study was to identify race/ethnicity differences in epidural uptake and postpartum pain management.

Study Design: Retrospective cohort study of all births in our hospital between 1/2019 and 12/2021, excluding patients with hysterectomy, intensive care unit stay, or transfusion with 4+ units of packed red cells. Opioid doses were measured in mean morphine equivalents (MEQs).

Results:

There were 18,282 patients with available race/ethnicity data.  Black and Hispanic patients were slightly younger, more often obese, and more often delivered preterm and by cesarean route than White and Asian patients.  There was no appreciable difference in the uptake of epidural for labor analgesia between race/ethnicity groups (Table 1).

The overall average maximum pain score following vaginal birth was 5, and 7 following cesarean birth. Black patients reported the highest pain scores of any race/ethnicity group regardless of delivery route. When the maximum pain score exceeded 5 for vaginal births or 7 for cesarean births, White patients received higher per-day opioid MEQs than did non-White patients. Interestingly, Asian patients reported the lowest pain scores and received the lowest per-day opioid MEQs when the maximum pain score was greater than the mean (Table 2). The above differences persisted after multivariable regression analyses adjusted for patient factors (maternal age, body mass index, parity, and epidural use).

Conclusion:

Black patients reported the highest pain scores after vaginal and cesarean birth. When maximum postpartum pain scores were high, all non-White patient groups received lower per-day opioid MEQs than did White patients. Asian patients reported the lowest pain scores and received the lowest per-day opioid MEQs of any race/ethnicity group, when the maximum pain score was high.