Oral medication for post-Caesarean analgesia

Quadratus lumborum block for postoperative analgesia after cesarean section: a meta-analysis of randomized controlled trials with trial sequential analysis

The aim of this study was to assess the analgesic efficacy of QLB versus controls in women undergoing cesarean section (CS). We systematically searched Cochrane Library, PUBMED, EMBASE, VIP, WANFANG, and China National Knowledge Infrastructure. Trials were eligible if parturients received QLB during CS. GRADE system was used to assess the certainty of evidence and Trial sequential analyses (TSA) were performed to determine whether the results are supported by sufficient data. Thirteen studies involving 1269 patients were included. Compared to controls, QLB significantly reduced the cumulative postoperative intravenous opioid consumption (in milligram morphine equivalents) at 24 h (MD, - 11.51 mg; 95% CI - 17.05 to - 5.96) and 48 h (MD, - 15.87 mg; 95% CI - 26.36 to - 5.38), supported by sufficient data confirmed by TSA. The postoperative pain scores were significantly reduced by QLB at 4 h, 6 h, 12 h, 24 h, and 48 h postoperatively by QLB compared with control. Moreover, the time to first request for rescue analgesic and the incidence of PONV were also significantly reduced by QLB. The quality of evidence of most results were low and moderate assessed by GRADE.

Postoperative Pain After Cesarean Birth Affects Breastfeeding and Infant Care

OBJECTIVE

To study women's experience of postoperative pain and pain relief after cesarean birth and factors associated with pain assessment and the birth experience.

DESIGN

Descriptive patient survey. Data were collected through a questionnaire. The outcome variables were assessments of pain using a Visual Analog Scale and women's birth experience measured on a seven-point Likert scale.

SETTING

Central Swedish county hospital, maternity unit.

PATIENTS/PARTICIPANTS

The sample consisted of 60 women undergoing cesarean birth.

RESULTS

Women reported high levels of experienced pain during the first 24 hours. Seventy-eight percent of the women scored greater than or equal to 4 on the Visual Analog Scale, which can be seen as inadequately treated pain. There was no difference between elective and emergency cesarean births in the levels of pain. In spite of high levels of pain, women were pleased with the pain relief. The risk of a negative birth experience was 80% higher for women undergoing an emergency cesarean birth compared with elective cesarean birth. Postoperative pain negatively affected breastfeeding and infant care.

CONCLUSIONS

There is a need for individual and adequate pain treatment for women undergoing cesarean birth, as high levels of pain interfere with early infant care and breastfeeding.

Evaluation of the pharmacokinetic profile and analgesic efficacy of oral morphine after total hip arthroplasty

BACKGROUND AND OBJECTIVE

Oral morphine may be useful for postoperative pain relief, but few studies have tested its use after in-hospital surgery.

METHODS

We evaluated clinical efficacy and the pharmacokinetic parameters of oral morphine after total hip arthroplasty. We recruited 60 patients who had total hip arthroplasty under general anaesthesia. The patients were randomized to receive placebo, 10 mg morphine sulphate or 20 mg morphine sulphate orally every 4 h for 24 h. The oral administration was started 3 h after the morphine-loading dose in the Post Anaesthesia Care Unit and then patients used intravenous morphine patient-controlled analgesia for 24 h. Pain score at rest (scored by patients on a visual analogue scale), sedation, nausea, vomiting and urinary retention were monitored. In 11 additional total hip arthroplasty patients, we determined the pharmacokinetics of morphine and its metabolites after oral administration of 20 mg morphine sulphate every 4 h for 16 h.

RESULTS

The amount of morphine administered via patient-controlled analgesia over 24 h was reduced in the 20-mg group compared with that in the placebo group (19.0 +/- 2.7 mg vs. 33.0 +/- 5.5 mg; P = 0.03). No significant morphine-sparing effect was observed in the 10-mg group. Pain scores and side-effects were similar in all groups. The pharmacokinetic study revealed a limited and slow absorption of morphine.

CONCLUSION

Despite a limited absorption of oral morphine postoperatively, high doses of oral morphine have a significant analgesic effect after total hip arthroplasty.

Over-the-counter oral analgesia for postcesarean pain

OBJECTIVE

The purpose of this study was to evaluate patient satisfaction for oral analgesia for postcesarean pain management.

STUDY DESIGN

A prospective study was conducted on women who underwent cesarean section with regional analgesia. Women were treated with ibuprofen 400 mg in liquid-filled capsules on the first postoperative day by two modes of drug administration: on patient demand (n = 60) and at predetermined regular intervals (n = 54). Pain intensity and satisfaction were self-evaluated by the patients with use of a visual analog scale.

RESULTS

Patients in the fixed time interval group had lower pain scores (by 38%-54%, P <.001) compared with the on-demand group. Satisfaction scores in both groups were high but superior in the fixed time interval group (87.5 +/- 18.8, median 94.5, vs 78.6 +/- 21, median 85, P <.001).

CONCLUSIONS

Oral, nonnarcotic, postcesarean analgesia provides satisfactory pain relief. Patient satisfaction can be further enhanced by providing the medications in fixed time intervals rather than leaving it to patient request.