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Analgesia post elective cesarean delivery: make it simple and make it work
Abstract Number: F-27
Abstract Type: Original Research
Introduction: Good management of acute post cesarean delivery (CD) pain reduces maternal morbidity and improves the patient experience, which may facilitate earlier hospital discharge. We aimed to evaluate our service and put in place interventions to improve post elective CD analgesia, as part of an enhanced recovery initiative.
Methods: Elective CD were prospectively audited from Oct-Dec 2014 (n=50) and re-audited from Oct-Dec 2016 (n=57). Data included postoperative pain scores, analgesia received, opioid requirements, whether mothers felt they waited too long to receive analgesia, length of hospital stay and patient-perceived cause of delay to discharge. After the 2014 audit, actions were taken to improve the service including communication of findings to women’s health; further audit of analgesia requirements evaluating the potential benefit of pre-filled syringes of oral morphine and requesting midwifery leads to seek necessary approvals for single-check oral morphine to reduce delays.
Results: (2014 vs. 2016). Regular post-CD analgesia received (100 vs. 98%); as required opioid analgesia received (63 vs. 66%); waited too long for analgesia (46 vs. 57%); pain score rated ‘severe’ on movement day 1 post-CD (46 vs. 41%); nausea post-CD (46 vs. 52%); length of stay (2.8 vs. 2.3 days); maternal satisfaction (85 vs. 79%). Causes of delay to discharge from the 2016 re-audit were described (Fig.1).
Discussion: Despite a drive to improve analgesic provision, pain following CD remains a significant issue at our institution and was the primary cause for delay to discharge. Relatively complex interventions were evaluated and planned after the 2014 audit, however after re-audit we have shifted our focus to more simple interventions: improving midwife and maternal education, disseminating these data to increase awareness that two-thirds of post elective CD mothers require additional opioid analgesia and over half feel they wait too long; a specific patient companion diary addressing analgesia through every step of enhanced recovery. We hope this will stimulate staff engagement and encourage proactive mothers. We suggest additional midwife-led pain rounds after regular rounds. We will re-evaluate the service following its implementation.
1. Kuczkowski, KM. Postoperative pain control in the parturient: new challenges in the new millennium. J Matern Fetal Neonatal Med. 2011; 24: 301-4.