Satisfaction Following Cesarean Section
Satisfaction Following Cesarean Section
Presently, the standard of care at the investigators' practice is that the discharging
 physician decides the type and amount of opioid medication to prescribe a patient following a
 cesarean section. After informed consent has been obtained, patients will be enrolled in this
 randomized-controlled equivalence study. The experimental group will be prescribed 20
 oxycodone-acetaminophen and the control group will be prescribed 28 oxycodone-acetaminophen
 at the time of discharge. Both groups will also be provided with a handout on non-opioid
 analgesia. The groups will be assigned randomly in blocks. The investigators will recruit
 patients either in the clinic, if participants are to have a scheduled cesarean section, or
 at some time during the hospital admission for delivery. The satisfaction survey and pain
 scale will be administered at the postoperative check by the clinic staff and providers.
 These surveys will be stored in a secure location at the clinic. If the patient does not show
 up for their postoperative visit, 3 attempts total will be made by an investigator to reach
 the patient and administer both surveys by phone within 2 weeks of discharge. A preliminary
 analysis of the data will be done once half the study patients have been recruited. The
 investigators do not foresee any threats to the external or internal validity of the study.
 The investigators are taking many measures to limit study bias. First, block randomization
 will help limit discrepancies between groups. Also, strict adherence to the inclusion and
 exclusion criteria will also help limit confounders that may make data difficult to
 interpret, such as non-opioid naïve patients and complications that may potentially increase
 pain and opioid requirements. Lastly, blinding of patients to the number of pills
 participants receive will help mitigate patient bias.
Presently, the standard of care at our practice is that the discharging physician decides the
 type and amount of opioid medication to prescribe a patient following a cesarean section.
 After informed consent has been obtained, patients will be enrolled in our
 randomized-control, equivalence study. The experimental group will be prescribed 20
 oxycodone-acetaminophen and the control group will be prescribed 28 oxycodone-acetaminophen
 at the time of discharge. Both groups will also be provided with a handout on non-opioid
 analgesia. The groups will be assigned randomly in blocks. The investigators will recruit
 patients either in the clinic, if participants are to have a scheduled cesarean section, or
 at some time during the hospital admission for delivery. The satisfaction survey and pain
 scale will be administered at the postoperative check by the clinic staff and providers. If
 the patient does not show up for their postoperative visit, 3 attempts total will be made by
 an investigator to reach the patient and administer both surveys by phone within 2 weeks of
 discharge. A preliminary analysis of the data will be done once half the study patients have
 been recruited. First, block randomization will help limit discrepancies between groups.

 Subject evaluation will generally be limited to no more than 3 weeks following surgery.
 Evaluations will occur at the postoperative visit via two surveys (see below). If the patient
 does not show up for the clinic visit, 3 attempts will be made by an investigator to reach
 the patient and administer both surveys by phone within 2 weeks of discharge.

 Variables of interest:

 1. Age

 2. Race

 3. Insurance

 4. Repeat cesarean section

 5. Classification of cesarean section (scheduled, unscheduled, emergent)

 6. Type of skin incision and closure

 7. Urine toxicology screen results

 8. Tubal ligation at the time of cesarean

 9. Anesthesia (General or regional [epidural, spinal or combined], if regional, duramorph
 given)

 10. Length of hospital stay

 11. Number of refills
Inclusion Criteria:

 1. Center for health services (CHS) patient

 2. Cesarean section

 3. >/= 18 years of age

 Exclusion Criteria:

 1. Non-CHS patients (i.e. regional or private)

 2. <18 years of age

 3. Allergy to hydrocodone, oxycodone, acetaminophen or NSAIDs

 4. Contraindication to using medications (i.e hypertensive disorders of pregnancy)

 5. Hospitalization >7 days, which suggest complications that may increase pain and opioid
 requirements

 6. Complications (wound infections, re-explorations, cesarean hysterectomies, etc…)

 7. Urine toxicology screen positive for opioids on admission

 8. Recent use as defined by either patient reported use of opioids within the last 30
 days or an Ohio Automated Rx Reporting System (OARRS) reports that shows prescription
 of opioids within 30 days of admission for delivery