Following Evidence-Based Recommendations for Perioperative Pain Management after Cesarean Section Is Associated with Better Pain-Related Outcomes: Analysis of Registry Data

Abstract

Women who have had a Cesarean Section (CS) frequently report severe pain and pain-related interference. One reason for insufficient pain treatment might be inconsistent implementation of evidence-based guidelines. We assessed the association between implementing three elements of care recommended by guidelines for postoperative pain management and pain-related patient-reported outcomes (PROs) in women after CS. The analysis relied on an anonymized dataset of women undergoing CS, retrieved from PAIN OUT. PAIN OUT, an international perioperative pain registry, provides clinicians with treatment assessment methodology and tools for patients to assess multi-dimensional pain-related PROs on the first postoperative day. We examined whether the care included [i] regional anesthesia with a neuraxial opioid OR general anesthesia with wound infiltration or a Transvesus Abdominis Plane block; [ii] at least one non-opioid analgesic at the full daily dose; and [iii] pain assessment and recording. Credit for care was given only if all three elements were administered (= “full”); otherwise, it was “incomplete”. A “Pain Composite Score-total” (PCStotal), evaluating outcomes of pain intensity, pain-related interference with function, and side-effects, was the primary endpoint in the total cohort (women receiving GA and/or RA) or a sub-group of women with RA only. Data from 5182 women was analyzed. “Full” care was administered to 20% of women in the total cohort and to 21% in the RA sub-group. In both groups, the PCStotal was significantly lower compared to “incomplete” care (p < 0.001); this was a small-to-moderate effect size. Administering all three elements of care was associated with better pain-related outcomes after CS. These should be straightforward and inexpensive for integration into routine care after CS. However, even in this group, a high proportion of women reported poor outcomes, indicating that additional work needs to be carried out to close the evidence-practice gap so that women who have undergone CS can be comfortable when caring for themselves and their newborn.

The Perioperative Pain Management Bundle is Feasible

“…Bundle-treated patients were less likely to want more treatment for pain. These findings are in line with an earlier study 29 where we found an association between an improved PCS and receipt of recommended elements of care in women undergoing cesarean section. In these patients, outcomes related to pain interference and side effects improved to a greater extent compared with intensity.…”

Understanding Kinesiophobia: Predictors and Influence on Early Functional Outcomes in Patients with Total Knee Arthroplasty

“…The Pain Side Effects (PSE) composite score was calculated from the scores for dizziness, drowsiness, nausea, and itching [30]. The Pain Composite Score-total (PCStotal) was formulated by averaging the continuous items derived from the pain intensity, pain interference, and side effects domains of the IPO-Q [31].…”

Cost-effectiveness of the Perioperative Pain Management Bundle a registry-based study

“…Per PAIN OUT protocol, pain-related PROs were obtained from patients using the International Pain Outcomes questionnaire (IPO-Q). The IPO-Q asks patients to evaluate their postoperative pain in terms of its intensity (worst and least pain, time spent in severe pain), the extent it interferes with activities (in bed, with coughing), sleep and emotions (anxiety and feeling of helplessness), side effects of analgesic medications (nausea, drowsiness, itchiness and dizziness), and how they perceive the care they receive, on an 11-point Numerical Rating Likert scales (28,29).…”