Open vs specific questioning during anaesthetic follow‐up after Caesarean section

Abstract

SummaryWords with negative emotional content such as pain or itch may enhance perception of these symptoms. We assessed open and direct questioning for symptoms in 100 women following Caesarean section. Of the 65 women reporting pain, 25 (39%) did so only when questioned specifically. Similarly, three women with bothersome pain (5%), and two requesting analgesia (3%), failed to disclose pain until questioned specifically. None of the 46 women with pain scores < 6 on a verbal numerical rating scale requested additional analgesia. Of 31 women with pruritus, two (6%) stated it bothered them and requested treatment and one (3%) failed to disclose pruritus on open questioning. Most women with bothersome pain or who request analgesia reveal this with open questioning. However, specific questioning is required to elicit pain in all patients. Most patients are bothered by pain at pain scores ‡ 6, while those with scores < 6 are unlikely to request additional analgesia. Effective communication is increasingly being recognised as an essential skill in anaesthetic practice [1][2][3]. It allows practitioners to develop rapport and trust with patients whilst enabling co-operation with their care, which in turn facilitates clinical management [4]. Anaesthetistpatient communication can play a vital role in alleviating anxiety [5] and enhancing analgesia, and is widely considered to be a required skill in today's medicolegal environment [6]. Although suspected for some time, only recently has it been shown that the way medical practitioners communicate can influence clinical outcomes. Lang et al. have shown that the use of negative suggestion or language with negative emotional content during painful invasive radiological procedures increases patients' pain and anxiety scores compared with the use of neutral or positive language [7]. Similarly, a recent randomised controlled trial has shown that the inadvertent use of language with negative emotional content to describe a sensation when inserting an intravenous cannula may not be helpful when compared with the use of neutral language [8]. Our anecdotal experience is that the use of negative suggestions is ubiquitous in our institution. For example, many patients are warned of a 'sting' before the injection of local anaesthetic. This in itself may increase the perception of a 'sting' rather than a 'numbing' sensation to allow the procedure to be performed more comfortably than otherwise. Similarly, the process of asking patients about pain or pruritus may function as a negative suggestion where the likelihood of patients' experiencing these symptoms may be increased. In attempting to develop a way to avoid introducing the potential for such changes in perception, we use a standardised neutral approach to patients in the form of initial open questioning regarding the presence or absence of symptoms such as pain or itch, followed by more specific questions where indicated. The questions asked have been routinely used by anaesthetists on the post-anaesthetic ward round of our insti...

A randomized comparative study assessing efficacy of pain versus comfort scores

“…Recently, studies have shown that women after cesarean section are more likely to report pain when asked “Do you have any pain?” compared with when women are asked “Are you comfortable?” for assessment of pain. [89] In our study also, we found that the incidence of reported pain was significantly more in Group P compared to Group C. This might be due to the reason that use of negative words gives a negative suggestion of sensations as pain that might have not been experienced otherwise.…”

“…[7] Recently, studies have documented that the use of word “comfort” rather than the word “pain” may affect patient's experience of their recovery. [8910] However, further investigations are needed to validate the results of these studies in our patient population.…”

Pain, Pain Relief, Satisfaction and Excellence in Obstetric Anesthesia: A Surprisingly Complex Relationship

“…This concept has been validated in a variety of other studies in obstetric anesthesia and other similar settings. [15][16][17][18][19] We can indeed influence our patient's experiences by small subtle behavioral changes! Third, anesthesiologists can enhance women's experience of care by advocating for changes in hospital policies and protocols that afford women greater control in birth.…”

What’s new in obstetric anesthesia?

“…is important to identify all patients who may benefit from treatment. 12 A survey of 100 women following cesarean delivery found that open questions (''How are you feeling?'' and ''Are you comfortable at the moment?'')…”