OPIOID SPARING STRATEGIES FOR OBSTETRIC SURGERY: BRINGING ERAS INTO THE CESAREAN SECTION SUITE Gregory Collins, DNP, CRNA

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1 OPIOID SPARING STRATEGIES FOR OBSTETRIC SURGERY: BRINGING ERAS INTO THE CESAREAN SECTION SUITE Gregory Collins, DNP, CRNA

2 FINANCIAL DISCLOSURES: NONE OFF-LABEL DRUG USAGE: ONDANSETRON DEXAMETHASONE

3

4 REVIEW IDENTIFY PROPOSE Review the origins of ERAS and the history of ERAS strategies in OB surgery. Identify strategies shown to reduce opioid consumption after CS. Propose means of evaluation and methods for implementing ERAS strategies.

5

6

7

8 2017

9 CESAREAN SECTION POST-OP COMPLICATIONS MATERNAL EXPERIENCE PAIN MANAGEMENT

10

11

12

13 CESAREAN SECTION MATERNAL EXPERIENCE PAIN MANAGEMENT POST-OP COMPLICATIONS

14

15 PREOPERATION INTRAOPERATION POSTOPERATION

16 PREOPERATION ALLOW LIGHT MEAL UP TO 6 HOURS BEFORE SURGERY

17 PREOPERATION ALLOW LIGHT MEAL UP TO 6 HOURS BEFORE SURGERY ENCOURAGE CARB-RICH CL UP TO 2 HOURS BEFORE SURGERY

18 PREOPERATION ALLOW LIGHT MEAL UP TO 6 HOURS BEFORE SURGERY ENCOURAGE CARB-RICH CL UP TO 2 HOURS BEFORE SURGERY INITIATE PHARMACOLOGICAL ASPIRATION PROPHYLAXIS

19 PREOPERATION ALLOW LIGHT MEAL UP TO 6 HOURS BEFORE SURGERY ENCOURAGE CARB-RICH CL UP TO 2 HOURS BEFORE SURGERY INITIATE PHARMACOLOGICAL ASPIRATION PROPHYLAXIS PREGABALIN 100 mg PO 1 HOUR BEFORE SURGERY

20 INTRAOPERATION ACETAMINOPHEN 1000 mg IV BEFORE INCISION

21 INTRAOPERATION ACETAMINOPHEN 1000 mg IV BEFORE INCISION ONDANSETRON 4-8 mg IV JUST PRIOR TO SAB PLACEMENT

22 INTRAOPERATION ACETAMINOPHEN 1000 mg IV BEFORE INCISION ONDANSETRON 4-8 mg IV JUST PRIOR TO SAB PLACEMENT PF MORPHINE 100 mcg INTRATHECAL WITH SAB

23 INTRAOPERATION ACTIVE, FORCED-AIR PATIENT WARMING

24 INTRAOPERATION ACTIVE, FORCED-AIR PATIENT WARMING DEXAMETHASONE 8 mg IV AFTER CORD CLAMP

25 INTRAOPERATION ACTIVE, FORCED-AIR PATIENT WARMING DEXAMETHASONE 8 mg IV AFTER CORD CLAMP CONSIDER TRANSVERSUS ABDOMINUS PLANE BLOCK

26 INTRAOPERATION

27 INTRAOPERATION

28 INTRAOPERATION

29 INTRAOPERATION

30 Reprinted from Block Buddy application.

31 Reprinted from Block Buddy application.

32 Reprinted from Block Buddy application.

33 SQ EOM IOM TAM VENTRAL DORSAL VENTRAL DORSAL

34 VENTRAL DORSAL

35 VENTRAL DORSAL

36 VENTRAL DORSAL VENTRAL DORSAL

37 INTRAOPERATION

38 POSTOPERATION ENCOURAGE EARLY ORAL INTAKE

39 POSTOPERATION ENCOURAGE EARLY ORAL INTAKE ENCOURAGE EARLY REMOVAL OF URINARY CATHETER

40 POSTOPERATION ENCOURAGE EARLY ORAL INTAKE ENCOURAGE EARLY REMOVAL OF URINARY CATHETER ACETAMINOPHEN 1000 mg IV/PO EVERY 6 HOURS

41 POSTOPERATION ENCOURAGE EARLY ORAL INTAKE ENCOURAGE EARLY REMOVAL OF URINARY CATHETER ACETAMINOPHEN 1000 mg IV/PO EVERY 6 HOURS KETOROLAC 30 mg IV EVERY 6 HOURS

42 EDUCATION

43

44

45

46

47

48

49 Stolen from Tom Baribeault s FaceBook post

50 OUTCOMES?

51

52 QUESTIONS?

53 REFERENCES Hebbard P. Transversalis fascia plane block, a novel ultrasound-guided abdominal wall nerve block. Canadian Journal of Anesthesia/Journal canadien d'anesthésie. 2009;56(8): doi: /s Hutchins J, Renfro L, Orza F, Honl C, Navare S, Berg A. The addition of intrathecal morphine to a transversus abdominis plane block with liposome bupivacaine provides more effective analgesia than transversus abdominis plane block with liposome bupivacaine alone: a retrospective study. Local Reg Anesth. 2019;12:7-13. Tulgar S, Serifsoy T. Transversalis fascia plane block provides effective postoperative analgesia for cesarean section: New indication for known block. J Clin Anesth. 2018;48: doi: /j.jclinane

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