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Post Cesarean Delivery Pain: A Quality Improvement Initiative
Abstract Number: F3I-215
Abstract Type: Original Research
Introduction:Cesarean delivery (CD) is the most common surgical procedure world wide and the incident is increasing.1 Pain management is crucial post CD to accelerate recovery of the mothers to go back to their normal daily activities. In addition, women with severe pain on the day after cesarean delivery have a 2.5- to 3-fold increased risk of postpartum depression and persistent pain 8 weeks later compared with those with mild pain.2 The rate of CD at our tertiary care academic obstetric center is 40%. Therefore, we conducted this quality improvement initiative to improve post operative pain management for patients undergoing elective CD, using the Plan-Do-Study-Act (PDSA) methodology.
Methods:Local REB approval was obtained for this study. Using numeric rating scale (NRS) for pain, we surveyed thirty five patients that underwent elective CD about their pain scores immediately after the procedure, at 24 hours and at 48 hours to determine our baseline data. Consequently, we conducted targeted interventions using the PDSA methodology to improve post cesarean delivery NRS. For PDSA cycle 1, we started with hospital staff education in regards pain management. This involved a weekly lecture for the nursing staff for a total of 4 weeks in addition to doing multidisciplinary rounds involving obstetricians and anesthesiologists, highlighting the importance and the deficits in the current pain management. For PDSA cycle 2, we implemented acute pain management service, where anesthesia would look after the patients’ pain management, implement multimodal analgesia and then transfer the patients’ care to the surgeons when appropriate. In addition,we looked at the overall analgesic consumption within 48 hours for all patients. We used a convenient sample to survey patients after each PDSA cycle to see if our interventions demonstrated any improvement in NRS. We recruited 37 and 35 patients in PDSA cycle 1 and 2 respectively.
Results: A total of 107 patients have been surveyed. At baseline measurement, mean NRS for pain at immediate, 24 hours and 48 hours were 2.3, 5.3 and 7.6,respectively. After implementing PDSA cycle 1, mean NRS were 1.8, 4.8 and 4.3 . In PDSA cycle 2, NRS were reduced substantially to 1.8, 3.5 and 3.5. at immediate ,24 hours and 48 hours compared to baseline group (Fig1).
Conclusions: Patients pain scores improved significantly after implementation of acute pain service and emphasizing the role of multimodal analgesia in pain management.