Improvements of post caesarean section pain management following the introduction of a new pain management protocol

Abstract

Objective To evaluate improvements in post-caesarean section (CS) pain management in University Obstetrics Unit, Ragama, Sri Lanka following the introduction of a protocol for post-CS pain management. Methods A complete audit cycle was conducted in University Obstetrics Unit, Ragama, Sri Lanka. Initially a prospective audit was conducted among 126 consecutive CS during July and August, 2016. Basic demographic data and details regarding post-CS analgesia during the first 24 hours were collected. Re-auditing was done four months after the introduction of the protocol. In the re-auditing, 150 post-CS mother were conveniently selected over a period of three months and a coloured visual analogue scale (VAS) was used to assess the level of pain in the re-audit. Results There were no statistically significant difference between demographic details before and after the protocol. Before introduction of the protocol, use of diclofenac sodium rectal suppositories were the commonest analgesic type (42.9%) used. Only 6 (4.8%) out of 126 patients had properly documented pain management plan in the operative notes. None of the analgesics were prescribed for 6 (4.8%) patients. Out of total 126, only 6 (4.8%) subjects had a proper drug chart maintenance with regular analgesics. Forty two (33.3%) women were was not on any analgesics within the first 24 hours. After introduction of the protocol, regular analgesic dosing were given to 140 (93.3%) women with satisfactory drug chart maintenance in 140 (93.3%) cases. Out of 150, 140 (93.3%) patients received analgesia with at least a single method. Mean VAS score was 3.5 (SD 2.0) after first 24 hours. Diclofenac sodium suppository (86.7%) is the commenst first line medication. There was statistically significant difference (P < 0.05) in provision of pain relief after introduction of the protocol. Conclusion There was a significant improvement in post-CS pain management after introduction of a new post-CS pain management protocol.