Obstetric Anaesthesia Annual Scientific Meeting 2025

Background

There are approximately 1500 caesarean births (CB) performed per year at the Royal United Hospital in Bath, with approximately 700 being elective CB with an average length of stay of 1.0 – 1.4 days. The recommended postoperative pain management consists of regular paracetamol and diclofenac (unless contraindicated). This minimises requirement for opiates such as dihydrocodeine and Oromorph, which can be given if needed. All patients receive intrathecal diamorphine unless contraindicated.

Problem

Routine review of postoperative pain scores on day 1 after CBdemonstrated that 31% of patients had significant pain (score>5), as well as an increase in opiate use. Poor compliance withadministration and prescribing regular paracetamol and anti-inflammatory analgesia was identified. There was increased useof dihydrocodeine and Oromorph instead.

Causes of this were :

Implementation of electronic prescribing, (EPMA) with veryspecific medication round times.
Knowledge gaps, especially in newly qualified midwives.
Lack of capacity of midwives on the ward to be able tocomplete regular patient review.

Initial tests of change were implemented ( PDSA CYCLE 1 ):

A standard prescription in EPMA was implemented to ensureparacetamol and diclofenac were prescribed regularly.
Education was given to all staff.

Following this prescribing of regular analgesia, the pain scoresinitially improved to 18% but was not sustained. Furthereducation improved scores again by April 2024, but this was stillunacceptably high (see figure 1). Further investigation wasundertaken to understand the problem, and further ideas weretested.

Aim statement

'A 50% reduction in pain scores on day 1 for patients having anelective CB by August 2025.'

Ideas for implementation were:

Introduction of voluntary self-administration of paracetamol anddiclofenac for elective caesarean births initially, enabling reliableadministration at individualised times to reduce pain scores.This would increase satisfactions and decrease opiate use.
Further education and training on pain relief to support the introduction of self-administered analgesia, ensuring clear messaging to patients from all staff.

Obstetric Anaesthesia Annual Scientific Meeting 2025

Tackling pain after caesarean birth with education and the challenges of introducing self-administration of pain relief on a postnatal ward

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