We sought to develop and implement an enhanced recovery after surgery (ERAS) pathway for cesarean delivery that would decrease postoperative opioid use in the inpatient setting while not compromising pain control. ERAS pathways have been adopted by other surgical fields but need more study in obstetrics. This is an IRB approved retrospective cohort study. Primary outcomes are postoperative, inpatient opioid use and patient reported postoperative pain scores. The ERAS pathway was started on 10/16/18 for all patients undergoing cesarean delivery. In-depth analysis included patients 3 months after the start of the ERAS pathway (n=267) compared to a historical control group 3 months prior at the same hospital (n=316). Data were collected via chart review of the electronic medical record. Opioid use, measured in morphine milligram equivalents (MME), was calculated using a validated analytics tool called Qlik Sense®. This tool was also used to track mean opioid use per patient on a monthly basis during ERAS implementation. Implementation of an ERAS pathway for cesarean delivery resulted in a significant decrease in opioid use per patient on each postoperative day and for the entire inpatient recovery period. After implementation of ERAS, median total postoperative opioid use was 30 MME (CI:27.5-37.5) per patient compared to 180.3 MME (CI:173-192.8) per patient prior to ERAS (p=0.028). With ERAS, 26% of patients never took an opioid during the postoperative recovery period. Before ERAS, 100% of patients took an opioid during recovery (p< 0.001). Median patient reported pain scores decreased with ERAS for postoperative days 1-3 (p< 0.001) and remained unchanged on day 4 (p=0.251). A 62% decrease in mean postoperative opioid use has been sustained for the past 8 months since starting ERAS compared to historical data for the past 2.5 years. An ERAS pathway for cesarean delivery significantly decreases postoperative opioid use in the inpatient setting while also providing better pain control. Patients undergoing cesarean delivery can benefit greatly from an ERAS pathway.View Large Image Figure ViewerDownload Hi-res image Download (PPT)