Audit on pain relief in obstetric patients after elective caesarean section
S.Cook, K. Purcell, S.Gibb, Sunderland Royal Hospital

1. Introduction

Elective Caesarean section (ELCS) is associated with moderate - severe pain which can impact recovery. Standard analgesia prescription in our unit comprises regular paracetamol and ibuprofen with PRN Oramorph as inpatient and five x 10mg doses ‘to take out’ (TTO). ‘PROSPECT’ guidelines1 support use of regular analgesia for ELCS. We aimed to assess if analgesia was administered regularly and the impact on women’s recovery.

2. Methods

We audited analgesia prescription, administration and patient recovery following ELCS by medical record review and postop patient questionnaire using the Obstetric Quality-of-Recovery Score (ObsQoR-11).2

The project was registered with the local Clinical Governance team.

We aimed to capture >58 women (10% of our yearly c-section workload)

3. Results

92 women were included, with 61 followed up via phone-call.

Regular paracetamol was prescribed in 91 women and ibuprofen in 84, this was given on time (+/- one hour) in only 8 and 14 women respectively.

Women who got on time simple analgesia used less Oramorph (Fig1).

Amount of TTO Oramorph (Fig2) given was felt to be enough in 48%, too little in 39%, too much in 3%, and 10% received none.

Average ObsQoR11 score was 85.6 (out of max. score 110), in those whose analgesia was on time it was 87.5 (ibuprofen) and 89.2 (paracetamol). Of the ObsQoR11 questions those with the lowest mean scores (0 = strongly agree, 10 = strongly disagree) were for moderate pain (4.2), severe pain (5.6) and comfort (6.5)

4. Discussion

Simple analgesia is prescribed regularly, but not given on time in most cases, which appears to correlate with higher opioid use. Average ObsQor11 scores fall below a ‘good recovery’ target (100) but are improved with regular analgesia. Lowest scores were for the questions related to pain and comfort. A large group of women felt they needed more Oramorph at home. Going forward we will advocate for improving analgesia delivery postnatally both by by introducing patient self-administration, and reviewing TTO opioid prescription

References

 1) E. Roofthooft, G. P. Joshi, N. Rawal, M. Van de Velde, PROSPECT guideline for elective caesarean section: updated systematic review and procedure-specific postoperative pain management recommendations, Anaesthesia 2022, 76, 665–680

2) Ciechanowicz S, Setty T, Robson E et al, Development and evaluation of an obstetric quality-of-recovery score (ObsQoR-11) after elective Caesarean delivery. British Journal of Anaesthesia. 2019;122(1):69-78.