Postoperative Analgesia Following Caesarean Section: Intravenous Patient Controlled Analgesia Versus Conventional Continuous Infusion

DOI: 10.4236/ojanes.2012.24028   PDF   HTML     6,609 Downloads   13,153 Views   Citations


Background: Management of postoperative pain after caesarean section (C/S) requires a balance between pain relief and undesirable side effects of drugs and technique. In order to improve postoperative pain management after caesarean section, we compared intravenous patient controlled analgesia (IV-PCA) with our current hospital practice, which is continuous opioid infusion. Method: We enrolled one hundred and twenty patients in our prospective randomized trial after an uneventful elective caesarean section under spinal anaesthesia. All patients received 0.5 mg/kg bolus of pethidine on first complaint of pain or at 120 minutes after institution of spinal anaesthesia. Depending upon the randomization, Group P received IV-PCA with 0.15 mg/kg bolus pethidine with 10-minute lockout and Group C received continuous pethidine infusion at a rate of 0.15 mg/kg/hr. Statistical analysis: For qualitative variables means and standard deviations were computed and analyzed by T-test, Mann Whitney U test and repeated measures ANOVA. Frequency and percentages were computed for qualitative data and analyzed by Chi-Square and Fischer exact test. A p-value of less than 0.05 was treated as significant. Results: The numeric rating score for pain, need for rescue analgesia and incidence of nausea and vomiting was significantly lower (p-value < 0.001) in IV-PCA group as compared to continuous infusion group at 6, 12 and 24 hours postoperatively, 98% of the patients were satisfied with pain management in Group P as compared to 70% (p < 0.001) in Group C. Conclusion: Our results showed improved pain control, less need for rescue analgesia for breakthrough pain, lower incidence of nausea and vomiting and greater patient satisfaction with IV-PCA. In the absence of preservative free narcotics for intrathecal use, postoperative pain management can be significantly improved by using IV-PCA instead of continuous opioid infusion in patients undergoing caesarean section.

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S. Ismail, G. Afshan, A. Monem and A. Ahmed, "Postoperative Analgesia Following Caesarean Section: Intravenous Patient Controlled Analgesia Versus Conventional Continuous Infusion," Open Journal of Anesthesiology, Vol. 2 No. 4, 2012, pp. 120-126. doi: 10.4236/ojanes.2012.24028.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] M. P. Bonnet, A. Mignon, J. X. Mazoit, Y. Ozier and E. Marret, “Analgesic Effect and Adverse Effects of Epidural Morphine Compared to Parenteral Opioids after Elective Caesarean Section: A Systemic Review,” European Journal of Pain, Vol. 14, No. 9, 2010, pp. 894-899. doi:10.1016/j.ejpain.2010.03.003
[2] D. A. Graves, R. L. Batenhorst, R. L. Bennett, et al., “Morphine Requirements Using Patient-Controlled Analgesia: Influence of Diurnal Variation and Morbid Obesity,” Clinical Pharmacology, Vol. 2, No. 1, 1983, pp. 49-53.
[3] American Society of Anesthesiologists Task Force on Pain Management, Acute Pain Section, “Practice Guidelines for Acute Pain Management in the Perioperative Setting,” Anesthesiology, Vol. 82, No. 4, 1995, pp. 10711081. doi:10.1097/00000542-199504000-00032
[4] M. Silvasti, N. Svartling, M. Pitkanen and P. H. Rosenberg, “Comparison of Intravenous Patient Controlled Analgesia with Tramadol versus Morphine after Microvascular Breast Reconstruction,” European Journal of Anaesthesiology, Vol. 17, No. 7, 2000, pp. 448-555.
[5] M. J. Paech, J. S. Moore and S. F. Evans, “Meperidine for Patient-Controlled Analgesia after Cesarean Section. Intravenous versus Epidural Administration,” Anesthesiology, Vol. 80, No. 6, 1994, pp. 1268-1276. doi:10.1097/00000542-199406000-00014
[6] K. A. Lehmann, “Recent Developments in Patient-Controlled Analgesia,” Journal of Pain and Symptom Management, Vol. 29, No. 5, 2005, pp. 72-89. doi:10.1016/j.jpainsymman.2005.01.005
[7] H. Owen, J. L. Plummer, I. Armstrong, L. E. Mather and M. J. Cousins, “Variables of Patient-Controlled Analgesia: 1. Bolus Size,” Anaesthesia, Vol. 44, No. 1, 1989, pp. 710. doi:10.1111/j.1365-2044.1989.tb11087.x
[8] J. Tsang and B. Brush, “Patient-Controlled Analgesia in Postoperative Cardiac Surgery,” Anaesthesia and Intensive Care, Vol. 27, 1999, pp. 464-470.
[9] J. J. Church, “Continuous Narcotic Infusions for Relief of Postoperative Pain,” British Medical Journal, Vol. 1, 1979, pp. 977-979. doi:10.1136/bmj.1.6169.977
[10] J. V. Stapleton, K. L. Austin and L. E. Mather, “A Pharmacokinetic Approach to Postoperative Pain: Continuous Infusion of Pethidine,” Anaesthesia and Intensive Care, Vol. 7, No. 1, 1979, pp. 25-32.
[11] Y. Al-Tamimi, K. F. Ilett, M. J. Paech, S. J. O’Halloran and P. E. Hartmann, “Estimation of Infant Dose and Exposure to Pethidine and Norpethidine via Breast Milk Following Patient-Controlled Epidural Pethidine for Analgesia Post Caesarean Delivery,” International Journal of Obstetric Anesthesia, Vol. 20, No. 2, 2011, pp. 128134. doi:10.1016/j.ijoa.2010.12.004
[12] J. A. Alhashemi, Q. A. Alotaibi, M. S. Mashaat, M. T. Kaid, R. H. Mujallid and M. A. Kaki, “Intravenous Acetaminophen vs Oral Ibuprofen in Combination with Morphine PCIA after Cesarean Delivery,” Canadian Journal of Anesthesia, Vol. 53, No. 12, 2006, pp. 12001206. doi:10.1007/BF03021581
[13] E. J. Van Beers, C. F. Van Tuijn, P. T. Nieuwkerk, P. W. Friederich, J. H. Vranken and B. J. Biemond, “Patient-Controlled Analgesia versus Continuous Infusion of Morphine during Vaso-Occlusive Crisis in Sickle Cell Disease, a Randomized Controlled Trial,” American Journal of Hematology, Vol. 82, No. 11, 2007, pp. 955960. doi:10.1002/ajh.20944
[14] C. Simanski, H. H. Waldvogel and E. Neugebauer, “Postoperative Nausea and Vomiting (PONV). Clinical Significance, Basic Principles, Prevention and Therapy,” Chirurg, Vol. 72, No. 12, 2001, pp. 1471-1426.
[15] L. H. Eberhart, W. Seeling, B. Ulrich, A. M. Morin and M. Georgieff, “Dimenhydrinate and Metoclopramide Alone or in Combination for Prophylaxis of PONV,” Canadian Journal of Anesthesia, Vol. 47, 2000, pp. 780-785. doi:10.1007/BF03019481
[16] D. Rüsch, K. Becker, L. H. Eberhart, et al., “Postoperative Nausea and Vomiting (PONV)—Recommendations for Risk Assessment, Prophylaxis and Therapy—Results of an Expert Panel Meeting,” Anasthesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie, Vol. 46, No. 3, 2011, pp. 158-170.
[17] C. H. Shu, Y. F. Liu, C. C. Tsou, Y. J. Hu and Y. C. Kuo, “Patient Controlled Analgesia Application to the Large Intestine Rectum Surgery,” Taiwan Medical Journal, Vol. 43, 2000, pp. 15-16.
[18] P. E. Macintyre, “Safety and Efficacy of Patient Controlled Analgesia,” British Journal of Anaesthesia, Vol. 87, 2001, pp. 36-46. doi:10.1093/bja/87.1.36
[19] C. Mann, F. Ouro-Bang’na and J. J. Eledjam, “Patientcontrolled analgesia,” Current Drug Targets, Vol. 6, 2005, pp. 815-819.
[20] G. Smith, “Pain after Surgery (Editorial),” British Journal of Anaesthesia, Vol. 67, 1991, pp. 233-234. doi:10.1093/bja/67.3.233
[21] R. S. Sinatra, K. Lodge, K. Sibert, K. S. Chung, J. H. Chung, A. Parker and D. M. Harison, “A Comparison of Morphine, Meperidine, and Oxymorphone as Utilized in Patient Controlled Analgesia Following Cesarean Delivery,” Anesthesiology, Vol. 70, No. 4, 1989, pp. 585-590. doi:10.1097/00000542-198904000-00005
[22] M. Bahar, M. Rosen and M. D. Vickers, “Self-Administered Nalbuphine, Morphine and Pethidine. Comparison, by Intravenous Route, Following Cholecystectomy,” Anaesthesia, Vol. 40, No. 6, 1985, pp. 529-532.
[23] A. Woodhouse, A. F. T. Hobbes, L. E. Mather and M. Gibson, “A Comparison of Morphine, Pethidine, and Fentanyl in the Post-Surgical Patient-Controlled Analgesia Environment,” Pain, Vol. 64, No. 1, 1996, pp. 115-121. doi:10.1016/0304-3959(95)00082-8
[24] R. McKenzie, T. Rudy and M. Ponter-Hammill, “Side-Effects of Morphine Patient-Controlled Analgesia and Meperidine Patient Controlled Analgesia: A Follow up of 500 Patients,” Journal of the American Association of Nurse Anesthetists, Vol. 60, No. 3, 1992, pp. 282-286.
[25] H. Unlugenc, M. A. Vardar and S. Tetiker, “A Comparative Study of the Analgesic Effect of Patient-Controlled Morphine, Pethidine, and Tramadol for Postoperative Pain Management after Abdominal Hysterectomy,” Anesthesia & Analgesia, Vol. 106, No. 1, 2008, pp. 309-312.
[26] American Academy of Pediatrics, Committee on Drugs, “Transfer of Drugs and Other Chemicals into Human Milk,” Pediatrics, Vol. 108, No. 3, 2001, pp. 776-789.
[27] M. F. Khan, O. B. Omole and G. J. O. Marincowitz, “Postoperative Analgesia Following Caesarean Deliveries in a Rural Health District of South Africa,” Tropical Doctor, Vol. 39, No. 4, 2009, pp. 217-221. doi:10.1258/td.2009.070497
[28] S. M. Siddik, M. T. Aouad, M. I. Jalbout, L. B. Rizk, G. H. Kamar and A. S. Baraka, “Diclofenac and/or Propacetamol for Postoperative Pain Management after Cesarean Delivery in Patients Receiving Patient Controlled Analgesia Morphine,” Regional Anesthesia and Pain Medicine, Vol. 26, 2001, pp. 310-315.
[29] B. A. Amigboye and G. J. Hofmeyr, “Local Anaesthetic Wound Infilteration and Abdominal Nerves Block during Caesarean Section for Postoperative Pain Relief,” Cochrane Database of Systematic Reviews, Vol. 3, 2009, Article ID: CD006954.

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