Opioid use and abuse has become a major medical problem in the United States. Over
prescription of opioid medications is a major contributor to this growing problem. Cesarean
delivery (CD) is the most commonly performed surgery in the US and women are generally given
opioid medications for postoperative pain management. This is not a common practice in other
developed countries. We believe that a multimodal pain management strategy is superior to
current practices for control of postoperative pain after CD and will lead to a decrease in
the use of opioid medications. This will have beneficial effects on patients' recovery and
bonding with their newborns, as well as societal effects in reducing the burden of opioid
abuse in the US. Our objective is to investigate the use of a multimodal pain regimen in
pregnant patients undergoing CD. This is a randomized double-blinded, placebo controlled
trial. The multimodal intervention consists of a pre-operative dose of IV acetaminophen
(Ofirmev), infiltration of subcutaneous bupivacaine prior to skin incision, and a dose of IM
ketorolac at time of fascial closure. These study medications are currently used in our
patient population but not in a standardized fashion, not in every patient, and not always in
combination with each other. The control group will receive placebo IV infusion
preoperatively and an IM injection at fascial closure, and subcutaneous infiltration with
normal saline before skin incision. Both groups will receive spinal regional anesthesia as
per anesthesia team and then postoperatively, both groups will receive the current standard
of care, which consists postoperative hydrocodone/acetaminophen and ibuprofen as needed
depending on pain score. Our primary outcome of interest will be the total opioid intake in
the first 48 hours after surgery. Secondary outcomes include time to first opioid given, pain
scores at 6-12, 24 and 48 hours post op, and total number of opioid tablets left after
discharge on post op day number 7. We will also evaluate patient satisfaction scores and
total length of hospital stay. We will evaluate neonatal outcomes including Apgar scores,
cord blood gases, immediate newborn complications in the first 48 hours after birth, and any
infant adverse outcomes related to maternal opioid use up to 4 weeks of life. Our hypothesis
is that our multimodal pain regimen will decrease the total opioid requirement in the first
48 hours after surgery.