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///2009 Abstract Details
2009 Abstract Details2019-08-03T15:55:31-05:00

Racial Differences in Pain Assessment and Management of Women who received Neuraxial Morphine for Post Cesarean Pain Control

Abstract Number: 103
Abstract Type: Original Research

Ashley M Tonidandel MD, MS1 ; Lynne C Harris RN2

Introduction: Despite social advances in the United States over the past few decades, the Institute of Medicine reports considerable discrepancies in the healthcare experience based on race and ethnicity.(1) Racial disparities extend to obstetric anesthesia, as evidenced by Glance et al.s recent publication demonstrating significant differences in epidural rates among white, black, and Hispanic laboring women.(2) These differences persisted despite similar insurance coverage, provider practice, and clinical characteristics.(2) This inequity prompted an "anesthesiologists call to action" editorial, strongly advocating for the need to "clearly establish an interdisciplinary pain disparities research agenda."(3) The purpose of this study is to examine whether racial differences exist in pain assessment and management of women who received neuraxial morphine for post Cesarean pain control.

Methods: Frequency of nursing assessments, pain scores, and management strategies, such as medication administration, will be recorded from a retrospective retrieval of computerized records for 24 hours after admission to mother-baby units. Demographic data will also be available, including self-reported race and ability to understand and communicate in English. Records of all women with Cesarean deliveries for a year will be examined. Patients with postoperative magnesium use will be excluded from analyses due to mandatory hourly assessments.

Results: To date, 76 of an estimated 1500 records have been retrieved. No results are statistically significant at this time due to small sample sizes. However, some potential trends are apparent. Interestingly, white patients have slightly lower pain scores (1.8 out of 10) compared to black (2.1) and Hispanic (2.2) patients. Despite lower pain scores, white patients have more frequent documentation of pain scores by nursing staff (8.8 in 24 hrs compared to 8.0 and 8.2) (see Figure).

Discussion: Prior research suggests that racial disparities in health care continue to exist. Data retrieval is ongoing and will allow for further exploration of racial and language differences in frequency of pain assessment and opioid administration after Cesarean section. If discrepancies exist, interventions to improve training of health care providers and empower patients will be the next logical step.

(1)J of the Natl Med Assoc 2002;94:666-8.

(2)Anesthesiology 2007;106:19-25.

(3)Anesthesiology 2007;106:6-8.

SOAP 2009