Observational study to assess the effectiveness of postoperative pain management of patients undergoing elective cesarean section.

Samina Ismail, Aga Khan University
Khurram Shahzad, Aga Khan University
Faraz Shafiq, Aga Khan University


Background: The study was designed to assess the strategy, effectiveness, and safety of postoperative pain management in Patients undergoing elective cesarean section in the obstetric unit of our hospital. Materials and Methods: Patients having elective cesarean section from December 2008 to May 2009 were included in this observational study. We recorded Patient's demographics, postoperative pain orders, and analgesia regime on the day of surgery. Anesthesia team, which included one of the investigators, assessed the overall pain since the time of surgery by visual analogue scale (VAS) and also recorded any complications since the time of surgery and Patients' satisfaction with the pain management. Results: A total of 263 Patients were reviewed during the study period. Postoperative analgesia regime was started by the obstetric team in 81% of Patients and in rest by the anesthesia team. The common modality of pain management was intravenous opioid infusion (94%) and coanalgesia was used in 99% of Patients. The analysis of pain at rest by VAS was between 1 and 3 in 89.7%, 4 and 6 in 9.5%, and 7 and 10 in 0.8% of Patients. The VAS on movement was 1-3 in 60.1%, 4-6 in 33.1%, and 7-10 in 6.8% of Patients. Patients' opinion regarding postoperative pain management was satisfactory in 91.6% of Patients and unsatisfactory in 8.4% of Patients. Overall, 9% of Patients had minor complications, which responded well to treatment. Conclusion: The regime for postoperative pain management was mostly started and followed by the obstetric team at the hospital. Although the postoperative pain management was adequate in terms of Patients' safety, it was not effective according to the goal set by Joint Commission on Accreditation of uniformly low pain score of not more than 3 out of 10 both at rest and with movement.