30 year old female now para 1 presented to the Emergency Department with
nausea, vomiting, and abdominal pain 6 days after an uncomplicated primary
cesarean delivery. She did not respond to conservative management and underwent
exploratory laparotomy for worsening pain, pneumoperitoneum and intraabdominal
fluid collections. Gastric perforations required repair via gastrojejunostomy.
Postoperative course was unremarkable. The anti-opioid campaign has altered the
approach to postoperative pain management in both positive and negative ways.
It has sparked new interest in alternative approaches to postoperative pain
management, which include an increased role for non-steroidal anti-inflammatory
drugs (NSAIDs). We present a case of a woman who had a significant complication
due to the reliance of non-opioid pain medications after cesarean delivery.
References
[1]
NIDA (2020) Emphasis Is Needed on Both Prevention and Treatment. National Institute on Drug Abuse.
https://www.drugabuse.gov/publications/research-reports/prescription-opioids-heroin/emphasis-needed-both-prevention-treatment
[2]
Volkow, N.D. and Collins, F.S. (2017) The Role of Science in Addressing the Opioid Crisis. The New England Journal of Medicine, 377, 391-394.
https://doi.org/10.1056/NEJMsr1706626
[3]
Young, J.C. et al. (2020) Persistent Opioid Use after Hysterectomy in the United States, 2005-2015. Obstet & Gynecol, 135, 123-132.
https://doi.org/10.1097/AOG.0000000000003612
[4]
Sun, E.C., Darnall, B.D., Baker, L.C. and Mackey, S. (2016) Incidence of and Risk Factors for Chronic Opioid Use among Opioid-Naive Patients in the Postoperative Period. JAMA Internal Medicine, 176, 1286-1293.
https://doi.org/10.1001/jamainternmed.2016.3298
[5]
American College of Obstetricians and Gynecologists (2018) ACOG Committee Opinion No. 742: Postpartum pain management. ObstetGynecol 2018 May 17; [e-pub].
[6]
Goldstein, J.L. and Cryer, B. (2015) Gastrointestinal Injury Associated with NSAID Use: A Case Study and Review of Risk Factors and Preventative Strategies. Drug, Healthcare and Patient Safety, 7, 31-41. https://doi.org/10.2147/DHPS.S71976
[7]
Bowen, K.R. and Baum, J.D. (2017) Life after Addiction—Post-Operative Pain Management in an Obstetrical Patient on Long-Term Buprenorphine Therapy. Open Journal of Obstetrics and Gynecology, 7, 951-956.
https://doi.org/10.4236/ojog.2017.79096
[8]
Rosenblum, A., Marsch, L.A., Joseph, H. and Portenoy, R.K. (2008) Opioids and the Treatment of Chronic Pain: Controversies, Current Status, and Future Directions. Experimental and Clinical Psychopharmacology, 16, 405-416.
https://doi.org/10.1037/a0013628
[9]
Hebbard, P., Soybel, D.I. and Chen, W. (2019) Partial Gastrectomy and Gastrointestinal Reconstruction.
https://www.uptodate.com/contents/total-gastrectomy-and-gastrointestinal-reconstruction?topicRef=15161&source=see_link
