title: Cost comparison of intrathecal morphine to intravenous patient-controlled analgesia for the first 24 h post cesarean delivery: a retrospective cohort study.
abstract: Intrathecal morphine provides superior pain control for patients undergoing cesarean delivery when compared to intravenous opioid patient-controlled analgesia. However, no study has assessed the overall cost associated with each modality as a primary outcome. The aim of this study is to determine the overall cost of each modality for the first 24 h post cesarean delivery.
  
  
  
  Charts of patients undergoing cesarean delivery at our institution from January 1, 2014 to December 31, 2014 were reviewed. Patients receiving intrathecal morphine were compared to patients undergoing general anesthesia and receiving intravenous opioid patient-controlled analgesia for post-procedure analgesia. The primary outcome measured was total cost of each modality for the first 24 h after delivery. Secondary outcomes included post-procedure pain scores, time to removal of the Foley catheter, need for rescue medications, and adverse events.
  
  
  
  There was a significant difference in total cost of intrathecal morphine when compared to intravenous opioid patient-controlled analgesia ($51.14 vs. $80.16, p < 0.001). Average pain scores between 0-1 h (0 vs. 5, p < 0.001) and 1-6 h (2.5 vs. 3.25, p < 0.001) were less in the intrathecal morphine group. The intrathecal morphine group received more ketorolac (p < 0.001) and required more rescue opioids (p = 0.042). There were no significant differences in documented adverse events.
  
  
  
  The use of intrathecal morphine for post-cesarean pain control leads to a significant cost savings for the first 24 h when compared to intravenous opioid patient-controlled analgesia. Patients also experienced less pain and were not at increased risk for adverse events.
authors.affiliation: Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, 619 19th Street South, JT 880, Birmingham, AL, 35249, USA.
authors.forename: Nitesh
authors.initials: N
authors.lastname: Patel
authors.affiliation: Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, 619 19th Street South, JT 880, Birmingham, AL, 35249, USA.
authors.forename: Ayesha
authors.initials: A
authors.lastname: Bryant
authors.affiliation: Department of Nursing, University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL, 35233, USA.
authors.forename: Kensi
authors.initials: K
authors.lastname: Duncan
authors.affiliation: Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, 619 19th Street South, JT 880, Birmingham, AL, 35249, USA.
authors.forename: Promil
authors.initials: P
authors.lastname: Kukreja
authors.affiliation: Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, 619 19th Street South, JT 880, Birmingham, AL, 35249, USA. mfpowell@uabmc.edu.
authors.forename: Mark F
authors.initials: MF
authors.lastname: Powell
mesh_terms: D000328:Adult; D016058:Analgesia, Patient-Controlled / Q000379:methods*; D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000191:economics* / Q000627:therapeutic use; D002585:Cesarean Section; D015331:Cohort Studies; D017046:Cost Savings; D005260:Female; D006801:Humans; D007275:Injections, Intravenous / Q000191:economics; D007278:Injections, Spinal / Q000191:economics; D009020:Morphine / Q000008:administration & dosage* / Q000191:economics* / Q000627:therapeutic use; D010147:Pain Measurement / Q000187:drug effects; D010149:Postoperative Pain / Q000188:drug therapy* / Q000191:economics* / Q000523:psychology; D011247:Pregnancy; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000701:Analgesics, Opioid; D009020:Morphine
keywords: Cost analysis; Intrathecal morphine; Post-cesarean pain control