An exploratory study in the UK of the effectiveness of three different pain management regimens for post-caesarean section women

Objective: to compare the effects of three types of analgesic administration after elective caesarean section on a number of clinical outcome measures. Supplementary aims of the study were to determine the acceptability of, and satisfaction with, the different regimens. Design: a quasi-experimental different subject design was used to compare three types of analgesic administration on pain, post-operative nausea and vomiting, analgesic consumption, length of hospital stay and overall satisfaction with pain management. Setting: a specialist women's hospital in a large UK city, with around 1500 caesarean sections per annum. Participants: 95 women who had undergone elective caesarean section. Interventions: the women were allocated to one of the three pain management groups: group 1 (oral morphine, Co-dydramol and diclofenac [all self-administered]); group 2 (oral morphine, Co-dydramol and diclofenac [all midwife-administered]); and Group 3 (intra-muscular morphine, oral Co-dydramol and diclofenac [all midwife-administered]). The safety of self-medication was measured by adherence to a safety protocol. Measurements: data collection was undertaken over the first 3 days after surgery and included visual analogue scale (0-100mm) pain scores, analgesic consumption, incidence of post-operative nausea and vomiting, and length of hospital stay. In addition, questionnaires were given to midwives and patients to assess the acceptability of self-medication and patient satisfaction. Data collection took place between June 2002 and June 2003. Findings: the results indicated that the outcomes of all three interventions were comparable in terms of pain scores, incidence of post-operative nausea and vomiting, and overall levels of satisfaction, although intra-muscular morphine was disliked to a degree that deterred some women from requesting it. Consumption of oral morphine was significantly greater than consumption of intramuscular injections of morphine, whereas Co-dydramol use was lower in the self-medicating group; the self-medicating women also went home, on average, a day earlier than women in the other two groups. (c) 2005 Elsevier Ltd. All rights reserved.