Implementation of a multimodal analgesic protocol after vaginal delivery and postpartum opioid consumption: a single-center retrospective study (2018-2023).

BACKGROUND: We investigated the effect of a standardized protocol with a multimodal order set on in-hospital opioid consumption and discharge prescription, emphasizing non-opioid medications over rescue oxycodone. METHODS: This single-center retrospective study examined vaginal delivery patients in 2018 (pre-protocol) and 2023 (post-protocol). Outcomes included inpatient opioid use, milligram morphine equivalents, and outpatient opioid prescriptions. Multivariable regression analyzed associations with clinical and demographic covariates. RESULTS: Unadjusted inpatient opioid administration decreased from 40.85% (2018, n = 2666) to 5.87% (2023, n = 2316) (P < 0.001), and among those administered opioids, there was an average decrease of 11.2 mg morphine equivalents (P < 0.001). Adjusted models showed that White patients, while inpatient, were 25% less likely to receive an opioid and given 2.98 mg morphine equivalents less compared with Black patients (P < 0.001). Outpatient prescription rates declined from unadjusted 19.2% to 1.9% (P < 0.001). CONCLUSIONS: Implementation of a multimodal analgesia regimen was associated with significant reductions in opioid exposure after vaginal delivery.