Observational study to assess the effectiveness of postoperative pain management of patients undergoing elective cesarean section

Abstract

Background:The study was designed to assess the strategy, effectiveness, and safety of postoperative pain management in patients undergoing elective cesarean section in the obstetric unit of our hospital.Materials and Methods:Patients having elective cesarean section from December 2008 to May 2009 were included in this observational study. We recorded patient's demographics, postoperative pain orders, and analgesia regime on the day of surgery. Anesthesia team, which included one of the investigators, assessed the overall pain since the time of surgery by visual analogue scale (VAS) and also recorded any complications since the time of surgery and patients’ satisfaction with the pain management.Results:A total of 263 patients were reviewed during the study period. Postoperative analgesia regime was started by the obstetric team in 81% of patients and in rest by the anesthesia team. The common modality of pain management was intravenous opioid infusion (94%) and coanalgesia was used in 99% of patients. The analysis of pain at rest by VAS was between 1 and 3 in 89.7%, 4 and 6 in 9.5%, and 7 and 10 in 0.8% of patients. The VAS on movement was 1–3 in 60.1%, 4–6 in 33.1%, and 7–10 in 6.8% of patients. Patients’ opinion regarding postoperative pain management was satisfactory in 91.6% of patients and unsatisfactory in 8.4% of patients. Overall, 9% of patients had minor complications, which responded well to treatment.Conclusion:The regime for postoperative pain management was mostly started and followed by the obstetric team at the hospital. Although the postoperative pain management was adequate in terms of patients’ safety, it was not effective according to the goal set by Joint Commission on Accreditation of uniformly low pain score of not more than 3 out of 10 both at rest and with movement.

Évaluation des pratiques de prise en charge analgésique en postopératoire de césarienne avant et après mesures d’amélioration

“…Plusieurs auteurs ont dé jà rapporté leurs difficulté s à obtenir ces ré sultats dans leurs maternité s respectives [16][17][18][19]. Dans la litté rature, les é tudes é valuant l'analgé sie postopé ratoire des cé sariennes par des é tudes contrôlé es rapportent des scores douloureux trè s bas, bien infé rieurs à ceux rapporté s dans les audits cliniques [5,25,26,34]. Cependant, ces é tudes n'ont pas é valué le niveau de douleur maximale mais la douleur moyenne, et souvent sur une pé riode de temps limité e aux 24 premiè res heures.…”

Effect of Anaesthesia Methods for Regaining Daily Life Activities in Cesarean Patients

“…Because uncontrolled pain may not only hinder optimal care of the mother with her baby, but also may unfavourably influence the interaction between the mother and baby in the early postpartum period (17). İsmail et al (11) stated that successful postoperative pain control after elective caesarean sections increase the quality of life. Because, women want to be attentive, energic and active in this period, in which they undertake the role of maternity that consists of many new activities such as nursing and baby care.…”

Effect of Intravenous Dexamethasone on Postoperative Nausea-Vomiting (PONV) after Intrathecal Morphine during Caesarean Section

“…During the entire duration of the study, pulse and blood pressure were recorded at the above said intervals. Pain was assessed by a 10 point Visual Analogue Scale (VAS) [18], with 0 being no pain and 10 being the worst imaginable pain. 75 mg IM diclofenac was given if VAS>3 or on patient demand any time during the first 24 hours.…”