A baseline audit of the efficacy and safety of an acute pain service (APS) for cesarean section patients

Abstract

Abstract This study was conducted as a baseline audit to evaluate the efficacy and safety of an acute pain service (APS) using recent new postoperative analgesic techniques for Chinese patients undergoing cesarean delivery, against which to assess future practice. This was a prospective study conducted in a 12-month period on ASA one to two women presenting at term for elective or emergency cesarean section in our hospital. All patients received a standard general anaesthesia, spinal or epidural anaesthesia for surgery deemed suitable by the attending anaesthetist. The patients were allocated to either receive intrathecal morphine or intravenous patient-controlled analgesia (PCA) morphine for postoperative analgesia. Intrathecal morphine was given to patients that received spinal anaesthesia and patient approval. The rest of the patients received a PCA. In addition, all patients were given non-opioid analgesics, for postoperative analgesia. Postoperative pain, patient satisfaction, adverse effects and complications were assessed. Four hundred and sixty-five patients were treated with patient-controlled analgesia (244 patients) or intrathecal morphine (221 patients). The mean age was 31 (17–44) years and body weight 67 (46–101) kg. Method of anaesthesia included general anaesthesia (45 patients), spinal anaesthesia (305 patients) and epidural anaesthesia (115 patients). Pain control was good: less than 1.3% of patients complained of severe postoperative pain. Complete patient satisfaction with the method of analgesia was 92.2%; partial satisfaction 7.3% and less than 0.5% was dissatisfied. Adverse effects and complications included nausea and vomiting (11%), pruritus (29%), sedation (0.2%), dizziness (10%), urinary retention (51%), postdural puncture headache (0.4%) and wound infection (2%). Our experience provides a useful baseline audit data in the Chinese population against which to assess and improve future practice.