Postoperative Analgesia Following Caesarean Section: Intravenous Patient Controlled Analgesia Versus Conventional Continuous Infusion

Abstract

Background: Management of postoperative pain after caesarean section (CS) requires a balance between pain relief and undesirable side effects of drugs and technique. In order to improve postoperative pain management after caesarean section, we compared intravenous patient controlled analgesia (IV-PCA) with our current hospital practice, which is continuous opioid infusion. Method: We enrolled one hundred and twenty patients in our prospective randomized trial after an uneventful elective caesarean section under spinal anaesthesia. All patients received 0.5 mg/kg bolus of pethidine on first complaint of pain or at 120 minutes after institution of spinal anaesthesia. Depending upon the randomization, Group P received IV-PCA with 0.15 mg/kg bolus pethidine with 10-minute lockout and Group C received continuous pethidine infusion at a rate of 0.15 mg/kg/hr. Statistical Analysis: For qualitative variables means and standard deviations were computed and analyzed by T-test, Mann Whitney U test and repeated measures ANOVA. Frequency and percentages were computed for qualitative data and analyzed by Chi-Square and Fischer exact test. A p-value of less than 0.05 was treated as significant. Results: The numeric rating score for pain, need for rescue analgesia and incidence of nausea and vomiting was significantly lower (p-value < 0.001) in IV-PCA group as compared to continuous infusion group at 6, 12 and 24 hours postoperatively, 98% of the patients were satisfied with pain management in Group P as compared to 70% (p < 0.001) in Group C. Conclusion: Our results showed improved pain control, less need for rescue analgesia for breakthrough pain, lower incidence of nausea and vomiting and greater patient satisfaction with IV-PCA. In the absence of preservative free narcotics for intrathecal use, postoperative pain management can be significantly improved by using IV-PCA instead of continuous opioid infusion in patients undergoing caesarean section.

Erector spinae plane block and transversus abdominis plane block for postoperative analgesia in cesarean section: A prospective randomized comparative study

“…A case report using bilateral ESP block for post-cesarean section analgesia at T9 level with 20 ml of 0.5% bupivacaine reported providing effective and long-lasting postoperative analgesia[ 17 ] and our study showed comparable effect with a significant reduction in analgesic consumption, VAS score over a period of 48 h and mean time of rescue analgesia administration of 43.53 h with ESP block.…”

Perioperative analgesia after intrathecal fentanyl and morphine or morphine alone for cesarean section

“…However, the postoperative pethidine requirement in the relevant CS studies has been reported to be 360 to 680 mg in patients who received placebo (ie, no intrathecal opioids). [ 48 , 49 ] In light of these results, our margin of 7% to 14% of this requirement appears to be reasonable. If we have decreased the noninferiority margin to 40 mg, the sample size of 24 patients per group would not exceed the number of patients that we have studied, but the inference of the noninferiority trial would be inconclusive.…”

Ultrasound-guided transversus abdominis plane block for post-operative analgesia in patients undergoing caesarean section

“…Opioids have been effectively used to provide post-operative analgesia after caesarean section. Various studies have been conducted in which opioids have been used IV,[ 4 ] intrathecally and also epidurally. [ 5 ] However, opioids are associated with complications such as respiratory depression, pruritus, sedation, nausea and vomiting.…”

“…[ 5 ] However, opioids are associated with complications such as respiratory depression, pruritus, sedation, nausea and vomiting. [ 4 5 ] Non-steroidal anti-inflammatory drugs are commonly used but are associated with complications such as bleeding tendencies, uterine atony and gastrointestinal bleeding. [ 6 7 ] Ketamine can also be used, but it affects interaction between the mother and the new-born.…”