Pain management and opioid use after caesarean section: a prospective observational cohort study

Abstract Background Effective pain management after caesarean section (CS) is vital. Standard fixed‐quantity discharge opioid prescribing may not align with individual clinical requirements. Aim To determine the adequacy of standard fixed‐quantity discharge supply of opioid analgesic after CS, evaluate post‐CS opioid consumption, and identify variables influencing postoperative opioid requirements. Method This prospective, observational cohort study evaluated patients who birthed via CS and were discharged with 10 opioid tablets. Pre‐ and post‐discharge questionnaires assessed analgesic utilisation and patient satisfaction with pain management. Clinical variables were extracted from electronic medical records to compare characteristics of patients reporting adequate versus inadequate supplies. Ethics approval was granted by the Western Health Office for Research (Reference no: QA/109151/WH‐2024‐435 023(v3)) and the study conforms with the Australian Ethical considerations in quality assistance and evaluation activities . Informed consent for post‐discharge contact by a study investigator and investigator access to medical and real‐time prescription monitoring records was obtained from all participants via distribution of study information indicating participation was voluntary and could be withdrawn at any time and the completion of written consent forms. Results Of the 119 participants included, the standard opioid supply was inadequate for 23.5% ( n = 28) of participants. Patients reporting an inadequate supply had higher mean daily inpatient opioid consumption (39.49 mg versus 21.25 mg oral morphine equivalent dose, p < 0.0001) and higher prevalence of body mass index (BMI) ≥35 kg/m 2 (50% versus 15.4%, p = 0.0001). Inpatient administration of simple analgesics was frequently delayed, and post‐discharge adherence was low across both cohorts. While inpatient satisfaction was high and comparable between groups, the inadequate supply group reported significantly lower post‐discharge satisfaction (55% versus 96%, p < 0.0001). In contrast, 48% ( n = 35) of 73 questionnaire respondents with adequate supply utilised ≤2 tablets post‐discharge. Conclusion Fixed‐quantity opioid prescriptions fail to meet postoperative requirements for a meaningful proportion of patients while simultaneously contributing to community opioid oversupply. Individualised discharge prescribing models incorporating inpatient opioid utilisation trends and BMI should replace rigid allocations to optimise post‐caesarean care.