Abstract
BackgroundThere is little information about the current management of pain after obstetric surgery at Mulago hospital in Uganda, one of the largest hospitals in Africa with approximately 32,000 deliveries per year. The primary goal of this study was to assess the severity of post cesarean section pain. Secondary objectives were to identify analgesic medications used to control post cesarean section pain and resultant patient satisfaction.MethodsWe prospectively followed 333 women who underwent cesarean section under spinal anesthesia. Subjective assessment of the participants’ pain was done using the Visual Analogue Scale (0 to 100) at 0, 6 and 24 h after surgery. Satisfaction with pain control was ascertained at 24 h after surgery using a 2-point scale (yes/no). Participants’ charts were reviewed for records of analgesics administered.ResultsPain control medications used in the first 24 h following cesarean section at this hospital included diclofenac only, pethidine only, tramadol only and multiple pain medications. There were mothers who did not receive any analgesic medication. The highest pain scores were reported at 6 h (median: 37; (IQR:37.5). 68% of participants reported they were satisfied with their pain control.ConclusionAdequate management of post-cesarean section pain remains a challenge at Mulago hospital. Greater inter-professional collaboration, self-administered analgesia, scheduled prescription orders and increasing availability of analgesic drugs may contribute to improved treatment of postoperative pain with better pain scores.
Highlights
There is little information about the current management of pain after obstetric surgery at Mulago hospital in Uganda, one of the largest hospitals in Africa with approximately 32,000 deliveries per year
In low-income countries, postoperative pain management can be challenging for several reasons including the expectation of postoperative pain by patients and the high patient-to-nurse ratio that limits assessment of pain and administration of adequate pain relief medication [4]
At Mulago National Referral Hospital, a tertiary teaching hospital, it has been shown that patients have inadequate pain control after orthopedic and general surgery [5], but little is known about the postoperative pain management after obstetric surgery
Summary
There is little information about the current management of pain after obstetric surgery at Mulago hospital in Uganda, one of the largest hospitals in Africa with approximately 32,000 deliveries per year. Secondary objectives were to identify analgesic medications used to control post cesarean section pain and resultant patient satisfaction. Treated postoperative pain can contribute significantly to morbidity of surgical patients, resulting in the delay of patients’ recovery and ability to return to daily functional activities [1]. Evidence from studies done in high income settings has demonstrated that inadequately treated pain after cesarean section is associated with an increased incidence of chronic pain [2] and post-traumatic stress syndrome [3]. At Mulago National Referral Hospital, a tertiary teaching hospital, it has been shown that patients have inadequate pain control after orthopedic and general surgery [5], but little is known about the postoperative pain management after obstetric surgery. We hypothesized that women undergoing cesarean section do not have satisfactory postoperative pain management in the first 24 h after surgery
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