Bilateral tubal ligation and postoperative pain and opioid use after cesarean

Patients frequently ask whether bilateral tubal ligation (BTL) increases pain in the postpartum period. We examined the association between BTL and postoperative pain and opioid use. This is a secondary analysis of data from four prospective studies on opioid use after cesarean at a single institution. All studies queried patients on inpatient pain control and collected self-reported discharge opioid use starting POD14. Demographic and obstetric data were common to all studies as were four outcomes: pain scores (1-10) on POD1, inpatient opioid morphine milligram equivalents (MME) used, MME prescribed at discharge, and MME used postpartum. Inpatient opioid use was calculated as MME/hour to account for differential lengths of stay. Study 1 (N=196) was the only study where clinicians, not study personnel, prescribed opioids at discharge. Negative binomial models were used to examine ordinal outcomes and adjust for covariates given the overdispersed nature of most outcomes. Data were available on 943 patients, of whom 151 (16%) underwent BTL at the time of their cesarean. Patients with BTL differed significantly in demographic and obstetric characteristics from patients without BTL (Table 1). Patients with a BTL reported similar pain scores on POD1 but used more inpatient opioid MME. Opioid MME prescribed at discharge was similar between both groups including Study 1 participants. Discharge opioid use did not differ significantly between patients with and without BTL and duration of opioid use after discharge was similar. These findings did not change after adjusting for covariates (Table 2). Undergoing BTL at the time of cesarean is associated with more inpatient opioid use, however there were no associations between BTL and the amount or duration of opioid use after discharge. These data may help reassure patients who ask about risks associated with BTL that there are few differences in post discharge opioid use.View Large Image Figure ViewerDownload Hi-res image Download (PPT)