The following is a summary of “Nonsteroidal anti-inflammatory drug “allergy” labeling is associated with increased postpartum opioid utilization,” published in the March 2024 issue of Allergy & Immunology by Li, et al.
Effective management of postpartum pain is crucial, often starting with acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) before resorting to opioids. However, patients with a reported history of NSAID-induced adverse drug reactions (ADRs) may face challenges in receiving appropriate analgesia despite evidence suggesting many can safely tolerate NSAIDs. For a study, researchers sought to investigate the association between reported NSAID ADRs and postpartum opioid utilization.
A retrospective cohort study was conducted on birthing individuals within an integrated health system from January 1, 2017, to December 31, 2020. Study outcomes included postpartum inpatient opioid administrations and opioid prescriptions at discharge. Statistical analysis was performed on a propensity score–matched sample to align covariate distributions.
Among 38,927 eligible participants, 883 (2.3%) reported an NSAID ADR. Individuals with reported NSAID ADRs had a higher rate of receiving inpatient opioids postpartum compared to those without NSAID ADRs (49.5% vs. 34.5%, difference = 15.0%, 95% CI 11.4-18.6%). Additionally, patients with NSAID ADRs received a higher cumulative dose of opioids during their hospital stay, irrespective of delivery mode (median 30.0 vs. 22.5 morphine milligram equivalents [MME] for vaginal deliveries; median 104.4 vs. 75.0 MME for cesarean deliveries). Furthermore, the proportion of patients receiving opioid prescriptions at discharge was higher in the NSAID ADR group compared to the non-NSAID ADR group (39.3% vs. 27.2%, difference = 12.1%, 95% CI 8.6-15.6%).
Patients with reported NSAID ADRs demonstrated increased postpartum inpatient opioid utilization and were more likely to receive opioid prescriptions at hospital discharge compared to those without NSAID ADRs, regardless of delivery mode. The findings underscored the importance of reassessing NSAID tolerability and tailoring pain management approaches in the postpartum period to optimize patient care.
Reference: jacionline.org/article/S0091-6749(23)01516-6/abstract