Date Published: April 11, 2018
Author(s): Thomas Hesse, Andreas Julich, James Paul, Klaus Hahnenkamp, Taras I. Usichenko.
Recent advances in the treatment of postoperative pain (POP) have increased the quality of life in surgical patients. The aim of this study was to examine the quality of POP management in patients after CS in comparison with patients after comparable surgical procedures.
This was a prospective observational analysis in patients after CS in comparison with the patients of the same age, who underwent comparable abdominal gynaecological surgeries (GS group) at the university hospital. A standardised questionnaire including pain intensity on the Verbal Rating Scale (VRS-11), incidence of analgesia-related side effects, and incidence of pain interference with the items of quality of life and patients’ satisfaction with the treatment of POP was used.
Sixty-four patients after CS reported more pain on movement than the patients after GS (N=63): mean 6.1 versus 3.6 (VRS-11; P < 0.001). The patients after CS reported less nausea (8 versus 41%) and vomiting (3 versus 21%; P < 0.001) and demonstrated better satisfaction with POP treatment than the patients after GS: 1.4 (0.7) versus 1.7 (0.7) (mean (SD); VRS-5; P=0.02). The disparity between the high level of pain and excellent satisfaction with POP treatment raises the ethical and biomedical considerations of restrictive pharmacological therapy of post-CS pain.
New methods of analgesia and the organisational approach to analgesia, including the procedure-specific, multimodal analgesic protocols, may decrease the levels of postoperative pain (POP) and increase the quality of life of surgical patients [1–3]. Despite the advances in analgesia, caesarian section (CS) patients still experience high levels of postoperative pain in comparison with other surgeries [4, 5].
The data of 64 consecutive patients after CS and 63 women of the same age who underwent other surgical procedures were available for analysis. The ASA physiological status was comparable among the patients of both groups (Table 1). During CS, spinal anaesthesia (SpA) was performed in 48 patients, epidural anaesthesia (EA) in 7, and general anaesthesia (GA) in 9. All patients from the gynaecological surgery (GS) group received GA for surgery, and 4 patients received EA in addition to GA. The detailed number of surgical procedures in patients from the GS group is given in Table 2.
Using the validated questionnaire for monitoring the quality of POP treatment at a university hospital, we have observed that, despite the higher levels of clinically relevant pain (pain on movement after the surgery), the patients after caesarean section (CS) were more satisfied with the treatment of POP than the patients after comparable gynaecological surgeries.
The disparity between the high levels of pain and excellent satisfaction with POP treatment with low incidence of analgesic-related side effects raises the ethical and medical questions of restrictive pharmacological therapy of post-CS pain.