Postoperative pain after cesarean section: assessment and management in a tertiary hospital in a low-income country

Kintu, Andrew; Abdulla, Sadiq; Lubikire, Aggrey; Nabukenya, Mary; Igaga, Elizabeth Namugaya; Bulamba, Fred; Semakula, Daniel; Olufolabi, Adeyemi J.

doi:10.1186/s12913-019-3911-x

Cited by 69 publications

(58 citation statements)

References 10 publications

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“…In this study, the pain was signi cantly reduced in TAP group as compared to control group with statistical signi cance at 0, 6, 12, 24 hours when assessed during movement on bed including sitting, sleeping and deep breath. This was similar to study done in India and Islamabad-Pakistan which involved 60 participants, whereby TAP block showed less pain during movement resulted in earlier readiness for discharge, early ambulation, early resumption of bowel activity and was statistically signi cant with (p value=0.046) [15] [9] In Uganda RCT study comparing intrathecal morphine and TAP block showed the mean numerical rating score for intrathecal morphine vs. transversus abdominis plane blocks at 8 h,16hr and 24hr was signi cantly reduced for movement and cough in transversus abdominis plane blocks different from this study at 24hrs [16].In this study it was not statistically signi cant at all time when cough pain score was high on both groups. This could be because the pain of cesarean section essentially described into acute moderate to severe, has basically two components somatic (from abdominal wall incision) and visceral (from the uterus) which TAP act on somatic [14].…”

Section: Discussionsupporting

confidence: 86%

Efficacy of Trans-abdominis Plane Block for Post Cesarean Delivery Analgesia in Low-income Countries: a Phase Three Feasibility Study.

Sanga

Ndebea

Salim

et al. 2020

Preprint

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Background: Optimal pain control in a parturient woman undergoing caesarean section is essential for preventing complications such as venous thrombo-embolism and improving maternal satisfaction, early functional recovery, mother-baby bond and breastfeeding. Intentional pain assessment and adequate management to acceptable pain severity using multimodal methods can be achieved in low-middle income countries (LMICs).Aim: Is to assess the efficacy of transversus abdominis plane (TAP) block and satisfaction post cesarean delivery analgesia at Kilimanjaro Christian Medical Centre in Low-Income countries. Methods: The study population consisted of 72 participants who met criteria posted for elective and emergency caesarean section. They were blindly assigned into two groups: group A was the interventional group which received TAP block and standard pain management according to local protocols and consisted of 41 participants and group B was the control group which received standard pain management without TAP block and consisted of 31 participants. In Group A 30ml of 0.25% bupivacaine single shot was deposited in the TAP plane bilaterally for postoperative analgesia. Participants were randomized using a parallel method. Their demographics were recorded before surgery and visual analogue scale was used to assess postoperative pain at rest and on movement, and maternal satisfaction at 0hrs, 6hrs, 12hrs and 24hrs.Results: Total of 72 patients were analyzed using NRS with pain score at 0hr, 6hr and 12hr was significantly low by about 50% in Intervened group as compared to control group with (p-value (2 tail) of < 0.001 however at 24 hrs. was 0.272. Participant in group A had extra movements at 0hr, 6hrs and 12hrs with p-value <0.001 as compare to control cut had no significant difference when coughing. Martenal satisfaction with pain management was 95.1% with no reported adverse event.Conclusions: Trans Abdominis Plane block when used as part of multimodal pain management is more effective in managing post cesarean pain resulting in less physical limitation and high martenal satisfaction.Trail registration: Register in Pan African Clinical Trial Registry (PACTR) with no PACTR202011815473426 on 12 November 2020.

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Section: Discussionsupporting

confidence: 86%

Efficacy of Trans-abdominis Plane Block for Post Cesarean Delivery Analgesia in Low-income Countries: a Phase Three Feasibility Study.

Sanga

Ndebea

Salim

et al. 2020

Preprint

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“…The variations could be explained by larger and multicenter sample size and better practice on pain management in the developed United States of America. Another prospective survey in Uganda reported that the incidence of severe acute pain after CS at three time-points at Zero, 6 th and 24 th hr since surgery was 33%, 39% and 29% respectively [25]. In-contrast, the incidence of postoperative pain was much higher in our study at all time-points (2 nd , 12 th , and 24 th hr).…”

Section: Discussioncontrasting

confidence: 71%

Postoperative Pain After Cesarean Section at University of Gondar Comprehensive Specialized Hospital, Gondar, Northwest Ethiopia, 2019; a Cross-sectional Follow-Up Study

Berhe

Demelash

Hailekiros

et al. 2020

Preprint

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BackgroundCesarean section is one of the most common obstetric procedures worldwide. Following this, parturients experience moderate to severe pain in the acute postoperative period. Therefore, in resource-limited settings, for full utilization of basic analgesic modalities and to take appropriates interventions, it is vital to know about the magnitude of the problem and its factors.ObjectiveTo assess the prevalence and factors associated with postoperative pain after cesarean section at the University of Gondar Comprehensive Specialized Hospital (UoGCSH), Northwest Ethiopia, 2019.MethodsA hospital-based prospective follow-up study was conducted among parturients who undergo cesarean section in the University of Gondar Comprehensive Specialized Hospital, from mid-February to April 20, 2019, after approval of the ethical review committee. Consecutively, a total of 290 parturients were included with a response rate of 97%. To measure pain severity numerical rating scale was used. Data was entered into Epi-data version 4.2 and analyzed by SPSS version 20 (IBM Corporate). The association between independent factors and the outcome variable was determined at 95% CI with the chi-squared test, bivariate, and multivariate logistic regression. Hosmer-Lemeshow test was used to assess the goodness of fit. Variables with a p-value of < 0.05 were considered significant.ResultsIn this study, the incidence of moderate to severe post-operative pain after cesarean section was 85.5% (95% CI: 81.4%, 89.0%) within the first 24 postoperative hours. On the multi-variable analysis, preoperative anxiety (AOR: 2.3, 95% CI: 1.1, 4.9), history of previous cesarean section (AOR: 2.3, 95% CI: 1.1, 5.0), Pfannenstiel incision (AOR: 3.2, 95% CI: 1.3, 8.0) and absence of regional analgesia (AOR: 3.7, 95% CI: 1.7, 7.9) were significantly associated with moderate to severe postoperative pain after cesarean section.ConclusionsIn this study, a large proportion of parturients had experienced moderate to severe post-cesarean pain in the first 24 postoperative hours. Preoperative anxiety, history of previous cesarean section, Pfannenstiel incision, and parturients with no regional analgesia were significantly associated with post-cesarean pain. Pain severity needs to be assessed and documented by using pain-rating scales and there should be an interdisciplinary approach to provide adequate pain management in our hospital.

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“…The 4-to 6-h time interval was chosen to capture the worst pain after cesarean section as well as the peak effect of the quadratus lumborum block. 18 The 24-h time interval was chosen for oral morphine equivalent consumption because it potentially captures the maximal duration of the intervention examined (i.e., quadratus lumborum block).…”

Section: Primary and Secondary Outcomesmentioning

confidence: 99%

Postoperative Analgesic Effectiveness of Quadratus Lumborum Block for Cesarean Delivery under Spinal Anesthesia

Hussain¹,

Brull²,

Weaver³

et al. 2020

Anesthesiology

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Background Spinal morphine is the mainstay of postcesarean analgesia. Quadratus lumborum block has recently been proposed as an adjunct or alternative to spinal morphine. The authors evaluated the analgesic effectiveness of quadratus lumborum block in cesarean delivery with and without spinal morphine. Methods Randomized trials evaluating quadratus lumborum block benefits in elective cesarean delivery under spinal anesthesia were sought. Three comparisons were considered: spinal morphine versus spinal morphine and quadratus lumborum block; spinal morphine versus quadratus lumborum block; and no block or spinal morphine versus quadratus lumborum block. The two coprimary outcomes were postoperative (1) 24-h cumulative oral morphine equivalent consumption and (2) pain at 4 to 6 h. Secondary outcomes included area under the curve pain, time to analgesic request, block complications, and opioid-related side effects. Results Twelve trials (924 patients) were analyzed. The mean differences (95% CIs) in 24-h morphine consumption and pain at 4 to 6 h for spinal morphine versus spinal morphine and quadratus lumborum block comparison were 0 mg (−2 to 1) and −0.1 cm (−0.7 to 0.4), respectively, indicating no benefit. For spinal morphine versus quadratus lumborum block, these differences were 7 mg (−2 to 15) and 0.6 cm (−0.7 to 1.8), respectively, also indicating no benefit. In contrast, for no block or spinal morphine versus quadratus lumborum block, improvements of −18 mg (−28 to −7) and −1.5 cm (−2.4 to −0.6) were observed, respectively, with quadratus lumborum block. Finally, for no block or spinal morphine versus quadratus lumborum block, quadratus lumborum block improved area under the 48-h pain curve by −4.4 cm · h (−5.0 to −3.8), exceeding the clinically important threshold (3.96 cm · h), but no differences were observed in the other comparisons. Conclusions Moderate quality evidence suggests that quadratus lumborum block does not enhance analgesic outcomes when combined with or compared with spinal morphine. However, the block improves postcesarean analgesia in the absence of spinal morphine. The clinical utility of this block seems limited to situations in which spinal morphine is not used. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

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Postoperative pain after cesarean section: assessment and management in a tertiary hospital in a low-income country

Cited by 69 publications

References 10 publications

Efficacy of Trans-abdominis Plane Block for Post Cesarean Delivery Analgesia in Low-income Countries: a Phase Three Feasibility Study.

Efficacy of Trans-abdominis Plane Block for Post Cesarean Delivery Analgesia in Low-income Countries: a Phase Three Feasibility Study.

Postoperative Pain After Cesarean Section at University of Gondar Comprehensive Specialized Hospital, Gondar, Northwest Ethiopia, 2019; a Cross-sectional Follow-Up Study

Postoperative Analgesic Effectiveness of Quadratus Lumborum Block for Cesarean Delivery under Spinal Anesthesia

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