Comparison of Postoperative Opioid Consumption and Pain Scores in Primary Versus Repeat Cesarean Delivery in Opioid Naïve Patients

Chao, Amanda; Pasca, Ioana; Alschuler, Matthew; Lee, Jay; Woodfin, Michelle; Pugh, Justin K.; Austin, Briahnna; Ringer, Mark A.; Ramsingh, Davinder

doi:10.3390/jcm8122221

Cited by 6 publications

(5 citation statements)

References 19 publications

(24 reference statements)

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“…Uterine contraction pain is a form of visceral pain, which is characterized by inaccurate positioning, and mainly manifested as paroxysmal colic, mostly caused by postpartum uterine involution and paroxysmal contractions. Compared with a first cesarean section, patients receiving a second cesarean section have more severe, long-lasting, and frequent contractions and hyperalgesia (4)(5)(6). At present, PCIA is usually used clinically for postoperative analgesia of cesarean section.…”

Section: Discussionmentioning

confidence: 99%

“…The sample size was calculated on the basis of a pilot study that showed the effect of acupressure on labor pain intensity and labor duration (13). The VAS score for significant pain reduction during labor was one score based on visual analogue scale (6,14). Using the PASS software 15.0, α=0.05, and power =0.85, considering SD =1.4 and M0 =7.2 for the labor pain score and 10% drop out of subjects, the sample size was calculated to be 36 patients for each group.…”

Section: Sample Size Calculationmentioning

confidence: 99%

“…And it can also cause severe uterine contractions and paroxysmal pain in the lower abdomen (3). Due to scarred uterine hyperalgesia, long operation time, poor uterine elasticity, increased uterine involution and contraction, and increased oxytocin requirements in females receiving a second cesarean section, the degree of uterine contraction pain is more severe and frequent than that of a primipara (4)(5)(6).…”

Section: Introductionmentioning

confidence: 99%

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Nalbuphine 20 mg combined with sufentanil 2 μg/kg exerts a better postoperative analgesia effect in patients undergoing a second cesarean section: a randomised trial

Liu¹,

Lin²,

Li³

et al. 2022

Ann Palliat Med

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Background: Pain management following cesarean section remains a challenge, with many puerpera suffering from severe acute postoperative pain. And for a second cesarean section the degree of uterine contraction pain is more severe and frequent than that of a primipara. This study investigated the effect of different doses of nalbuphine combined with sufentanil for postoperative analgesia in patients undergoing a second cesarean section. Methods:We prospectively recruited 168 women with a scarred uterus undergoing elective second cesarean section and they were randomly divided into 4 groups by random number extraction. A single intravenous injection of different doses of nalbuphine was given before the intravenous drip of oxytocin, and visual analogue scale (VAS) scores of uterine contraction pain were recorded 10 minutes before intravenous infusion of oxytocin (T1) and 10 minutes (T2), 30 minutes (T3), and 60 minutes (T4) after intravenous infusion of oxytocin. At 4, 8, 12, 24, and 48 hours after patient-controlled intravenous analgesia (PCIA), pain intensity was reassessed using the VAS score.Results: One hundred and sixty patients underwent elective second cesarean section in between December 2020 and May 2021 completed the study. The VAS scores of uterine contractions at T1 and T4 were 3 (1.0), while the VAS scores at T2 and T3 were 7 (1.0), 6 (1.0), 5 (1.0), 5 (1.0) and 8 (1.0), 5 (2.0), 3 (1.0), 3 (0.75).The VAS scores at 12 hours after surgery of nalbuphine10mg and sufentanil (NS1), nalbuphine 10 mg and sufentanil 20 mg (NS2) and nalbuphine 30 mg and sufentanil 20 mg (NS3) were lower than sufentanil (S) group (P<0.001). Compared with the S group, total amount of sufentanil and PCIA compression numbers in the NS1, NS2, and NS3 groups at 4-8 and 8-12 hours after surgery decreased (P<0.001), with a more significant decrease in the NS2 and NS3 groups than in the NS1 group (P<0.001). The NS3 group had a significantly higher incidence of dizziness and sleepiness (P=0.02, P=0.001). Compared with the NS2 and NS3 groups, the incidence of respiratory depression in the S group was significantly higher (P=0.001).Conclusions: A single intravenous injection of nalbuphine 20 mg 10 minutes before the infusion of ^ ORCID: 0000-0002-9951-7434. oxytocin combined with sufentanil 2 μg/kg could be safely used for postoperative analgesia in patients undergoing a second cesarean section and could effectively inhibit uterine contractions induced by oxytocin and reduce adverse reactions.

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Section: Discussionmentioning

confidence: 99%

Section: Sample Size Calculationmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Nalbuphine 20 mg combined with sufentanil 2 μg/kg exerts a better postoperative analgesia effect in patients undergoing a second cesarean section: a randomised trial

Liu¹,

Lin²,

Li³

et al. 2022

Ann Palliat Med

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“…18 However, limited documentation of pain assessment and reassessment was observed. 19 The most used post-operative pain assessment tools are unidimensional and assess only pain intensity, which is just one aspect of the sensory dimension. 20 These include the Numerical Rating Scale (NRS) and the VRS.…”

Section: Discussionmentioning

confidence: 99%

A retrospective audit of pain assessment and management post-caesarean section at New Somerset Hospital in Cape Town, South Africa

Munsaka

Dyk

Parker

2021

South African Family Practice

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Background: The most common major surgical procedure performed worldwide is the caesarean section (CS). Effective pain management is a priority for women undergoing this procedure, to reduce the incidence of persistent pain (a risk factor for postpartum depression), as well as optimise maternal-neonatal bonding and the successful establishment of breastfeeding. Multimodal analgesia is the gold standard for post-CS analgesia. At present, no perioperative pain management protocols could be identified for the management of patients presenting for CS at regional hospitals in South Africa. This audit aimed to review the folders of patients who underwent CS, with particular reference to perioperative pain management guidelines for CS.Methods: A descriptive, retrospective, cross-sectional audit was conducted. Three hundred folders (10% of the annual number of caesarean procedures performed) from New Somerset Hospital, a regional hospital in Cape Town, South Africa were reviewed.Results: The women were a mean age of 30 years (standard deviation [s.d.]: 6.2). Median gravidity was 3 (interquartile range [IQR]: 2–3) and parity was 1 (IQR: 1–2); 52% had previously undergone a CS. In 93.3% cases, spinal anaesthesia was employed for CS. Pain assessment was poor, with only 55 (18%) patients having their pain assessed on the day of the operation. Analgesia was prescribed in over 98% of the patients, however, medication was only administered as prescribed in 32.6%. Non-steroidal anti-inflammatory drugs (NSAIDs) were prescribed in 5% of cases. None of the patients received a patient-controlled analgesia (PCA), transversus abdominis plane (TAP) block, or wound infusion catheter as supplementary strategies.Conclusion: Pain management for post-CS patient at this hospital is lacking. There is the need for the implementation of a structured assessment tool to improve administration of analgesics in these patients. In addition, the reasons for the omission of NSAIDs from the analgesia regimen requires investigation. Hospital requires post-CS pain protocols to guide management especially in resource-limited settings.

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“…Acute postsurgical pain has been associated with patient (e.g., age, preexisting psychiatric diagnoses, body mass index, smoking status), surgical (e.g., planned versus unplanned CD, primary versus repeat CD, operative time), and anesthetic (general versus regional anesthesia) factors [4][5][6][7][8][9]. Pre-procedural identification of women at increased risk for pain following CD can be used to optimize analgesia and potentially attenuate development of chronic effects [10].…”

Section: Introductionmentioning

confidence: 99%

Labor prior to cesarean delivery associated with higher post-discharge opioid consumption

et al. 2021

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Background Severe acute post-cesarean delivery (CD) pain has been associated with an increased risk for persistent pain and postpartum depression. Identification of women at increased risk for pain can be used to optimize post-cesarean analgesia. The impact of labor prior to CD (intrapartum CD) on acute post-operative pain and opioid use is unclear. We hypothesized that intrapartum CD, which has been associated with both increased inflammation and affective distress related to an unexpected surgical procedure, would result in higher postoperative pain scores and increased opioid intake. Methods This is a secondary analysis of a prospective cohort study examining opioid use up to 2 weeks following CD. Women undergoing CD at six academic medical centers in the United States 9/2014-3/2016 were contacted by phone two weeks following discharge. Participants completed a structured interview that included questions about postoperative pain scores and opioid utilization. They were asked to retrospectively estimate their maximal pain score on an 11-point numeric rating scale at multiple time points, including day of surgery, during hospitalization, immediately after discharge, 1st week, and 2nd week following discharge. Pain scores over time were assessed utilizing a generalized linear mixed-effects model with the patient identifier being a random effect, adjusting for an a priori defined set of confounders. A multivariate negative binomial model was utilized to assess the association between intrapartum CD and opioid utilization after discharge, also adjusting for the same confounders. In the context of non-random prescription distribution, this model was constructed with an offset for the number of tablets dispensed. Results A total of 720 women were enrolled, 392 with and 328 without labor prior to CD. Patients with intrapartum CD were younger, less likely to undergo repeat CD or additional surgical procedures, and more likely to experience a complication of CD. Women with intrapartum CD consumed more opioid tablets following discharge than women without labor (median 20, IQR 10–30 versus 17, IQR 6–30; p = 0.005). This association persisted after adjustment for confounders (incidence rate ratio 1.16, 95% CI 1.05–1.29; p = 0.004). Pain scores on the day of surgery were higher in women with intrapartum CD (difference 0.91, 95% CI 0.52–1.30; adj. p = <0.001) even after adjustment for confounders. Pain scores at other time points were not meaningfully different between the two groups. Conclusion Intrapartum CD is associated with worse pain on the day of surgery but not other time points. Opioid requirements following discharge were modestly increased following intrapartum CD.

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Comparison of Postoperative Opioid Consumption and Pain Scores in Primary Versus Repeat Cesarean Delivery in Opioid Naïve Patients

Cited by 6 publications

References 19 publications

Nalbuphine 20 mg combined with sufentanil 2 μg/kg exerts a better postoperative analgesia effect in patients undergoing a second cesarean section: a randomised trial

Nalbuphine 20 mg combined with sufentanil 2 μg/kg exerts a better postoperative analgesia effect in patients undergoing a second cesarean section: a randomised trial

A retrospective audit of pain assessment and management post-caesarean section at New Somerset Hospital in Cape Town, South Africa

Labor prior to cesarean delivery associated with higher post-discharge opioid consumption

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