Post-cesarean Pain Research Articles

The effect of deep tissue massage application on post cesarean women’s pain and anxiety

Background: The most frequent post-cesarean consequences include pain and anxiety which is uncomfortable for women and has increased the use of natural remedies such as deep tissue massage. Aim: To investigate the effect of deep tissue massage on post-cesarean women's pain and anxiety. Design: A quasi-experimental design was utilized to accomplish this study. Setting: The study was conducted at the postpartum department at Sohag University Hospital. Subjects: Included 100 post-cesarean women of a convenient sample assigned into two equal groups study and control) were enrolled in the previously selected setting. Tools: I: Demographic and obstetric assessment sheet, II: Visual Analogue Scale, and III: State-Trait Anxiety Inventory. Results: a highly statistically significant difference was found in post-cesarean women's pain and anxiety between the two groups p<0.01. Conclusion: Deep tissue massage application has a vital role in reducing post-cesarean women's pain and anxiety. Recommendations: Deep tissue massage is recommended to be applied for post-cesarean women to reduce post-cesarean pain and anxiety.

Morphine Spinal Anesthesia for Cesarean Section at the Regional Hospital of Saint Louis in Senegal: About 119 Cases Collected

Introduction: Post-operative pain management has been the subject of several studies worldwide. Cesarean section is a commonly performed procedure and can lead to severe pain. This study aimed to determine the quality of post-cesarean analgesia by intrathecal administration of 100 micrograms of morphine. Patients and Methods: We conducted an analytical and descriptive study with prospective data collection during one month. We included all women who underwent a spinal caesarean section. Results: During the study period, a total of 119 women were enrolled. The mean age of the parturients was 27.85. High blood pressure and obesity were the most common comorbidities in 9.242% and 5.09% of the women respectively, and 31.93% had a history of caesarean section. Cesarean sections were performed according to the level of urgency based on the colour code. Scheduled caesarean sections were performed in 64.7% of cases. Women had an APFEL score of 3 in 95% of cases. Bupivacaine 7.5mg was administered in 96.63% of cases. The average dose of ephedrine administered before fetal extraction was 3.96mg. Oxytocin was the most administered uterotonic in 73.94%. The APGAR score at birth was greater than 7 in 95.79% of cases. No patient expressed a need for additional analgesics after lifting the motor block. No respiratory or neurological complications of morphine were noted. Pruritus was present in 24.36% of cases, whereas nausea and vomiting were reported in 17.64%. There were no cases of acute urine retention. The average time for the resumption of bowel movement was 13.67 hours. Discussion and Conclusion: Morphine spinal analgesia is an effective technique for the management of post-cesarean pain. The reduction of the morphine dose to 100 micrograms and the preventive addition of dexamethasone are two key factors in accelerated rehabilitation after surgery.

Analgesic Effect of Preoperative Intravenous Administration of Paracetamol on Post-cesarean Pain: A Randomized Clinical Trial.

Pain control after every surgery, especially cesarean section, is very important, and physicians strive to discover pain control methods using the least amount of opioids. Paracetamol is a non-opioid analgesic with few complications. The present study aimed to investigate the analgesic effect of preoperative intravenous administration of paracetamol on post-cesarean pain. This randomized, double-blind clinical trial was conducted on 240 pregnant women under spinal anesthesia who were candidates for elective cesarean section. The patients' weight, height, age, and body mass index (BMI) were recorded, and patients were randomly divided into 2 equal groups (n = 120). In the first group, 10 mg/kg paracetamol in 100 mL of normal saline (paracetamol group) and, in the second group, 100 mL normal saline (control group) were administered 15 minutes before surgery intravenously. Blood pressure, pulse rate, chills, and nausea were recorded during and 1 hour after surgery; in addition, the visual analogue scale (VAS) and the need for additional analgesics were recorded 1, 2, 4, 6, 12, and 24 hours after surgery. Mean pain scores were significantly lower in the paracetamol group (4.01 ± 2.22) than in the control group 6 hours (4.83 ± 2.35; P = 0.008) and 24 hours (2.26 ± 1.85 and 2.67 ± 1.80, respectably; P = 0.038) after surgery. Mean meperidine consumption was lower in the paracetamol group than in the control group, but it was not significant. No significant difference was found between the 2 groups in the frequency of chills and nausea (P > 0.05). Within the limitations of the current study, preoperative intravenous administration of paracetamol significantly reduced post-cesarean pain within 24 hours.

Integrative medicine: what's new in 2022

To illustrate the news of 2022, we present first a scientific article on mindfulness: a meta-analysis shows both preventive and therapeutic effects for the pediatric population. A second scientific article is summarized: it investigated acupuncture in an obstetrical context, demonstrating its effectiveness on post-caesarean pain and on functional capacity, by improving early mobilization. Hence, these approaches have an increasing level of scientific evidence in these given fields, calling for a clinical implementation. Finally, we offer a practical summary concerning the prescription of cannabis, especially useful following the abolishment of the obligatory FOPH authorization as of August 1, 2022. Nevertheless, we underline that the evidence for cannabinoids being effective remains weak in most indications.

Effect of age of gravida on post-cesarean section pain: An observational study

Objective: Preoperative identification of women at greater risk of post-cesarean pain might allow more intensive analgesic interventions. This study aimed to assess the effect of age of a parturient on post-cesarean section (CS) pain. Methods: 100 pregnant females were enrolled and divided into 4 groups: group A (age 18–24 years), group B (25–30 years), group C (31–35 years), and group D (≥36 years). Patient-controlled epidural analgesia was started postoperatively in all patients. Pain on a 0- to 10-point visual analog scale (VAS), a number of attempts tried for patient-activated dose delivery of ropivacaine, and successful delivery of patient-activated dose of ropivacaine were recorded for 72 hours. Breastfeeding was initiated as early as possible. The effect of breastfeeding on post-CS pain was observed for 72 hours in terms of increase, decrease, or no change in VAS scores with breastfeeding. Results: The peak VAS scores over 72 hours were 4.10 ± 0.60, 4.00 ± 0.67, 3.75 ± 0.45, and 3.42 ± 0.67, respectively, in groups A, B, C, and D, showing a significant declining trend (P = 0.007). The mean VAS scores decreased from 4.08 to 1.69 (group A, P < 0.0001), from 4.00 to 1.64 (group B, P < 0.0001), from 3.67 to 1.25 (group C, P < 0.0001), and from 3.33 to 1.50 (group D, P < 0.0001) over 72 hours. A statistically significant decline in patient-activated rescue drug delivery attempts, the number of times the rescue analgesic was delivered, and 24-h cumulative ropivacaine dose requirement was seen. Conclusions: In this study, it was found that post-cesarean pain decreases significantly with increasing age, as evidenced by reduced pain scores, reduced attempts at rescue drug delivery, and reduced rescue analgesic requirements.

A randomized trial of individualized opioid prescription protocol versus fixed quantity for post-cesarean pain management

To evaluate whether an individualized opioid prescription protocol (IOPP) with a shared decision-making component is non-inferior to a fixed quantity prescription of opioid tablets for outpatient cesarean pain management at 1-week post-discharge. We performed a non-inferiority open-label trial at 31 US sites (NCT04296396). Prior to hospital discharge, participants who had undergone cesarean delivery were randomly assigned to IOPP or fixed quantity (20 tablets of 5mg oxycodone) and followed through 90 days postpartum. In the IOPP group, individuals received education on post-operative pain expectations, opioid side effects, and the number of recommended tablets based on their morphine milligram equivalent (MME) use in the past 24 hours. They then selected a quantity of post-discharge tablets (up to 20) to be prescribed. The primary outcome was moderate to severe pain (≥ 4) at 1-week post-discharge on the Brief Pain Inventory (BPI, 0-10) in the last 24 hrs. Secondary outcomes were pain scores and post-discharge opioid prescriptions within 90 days. A planned sample size of 5500 tested non-inferiority of IOPP compared to fixed quantity assuming 90% power, type I error 0.025 1-sided and inferiority margin of 5%. From Sep 2020 through March 2022, of 9963 eligible individuals, 5520 (55%) were enrolled (n=2748 IOPP, n=2772 fixed). Baseline characteristics were similar between groups. In the IOPP group, participants requested a median of 14 tablets (IQR range 6-20). The primary outcome rate was not inferior between the IOPP and fixed groups (59% vs. 60%, Risk Difference -0.7; 95% CI -3.4, 2.0), and worst pain was similar throughout follow-up (Figure). The proportion filling an opioid prescription after discharge was similar between groups (7.6% vs 6.2%, relative risk 1.22, 95% CI [1.00, 1.48]). Reported opioid-related side effects were similar between groups (13.5% vs. 13.9%, p=0.7). Compared to fixed quantity opioid prescription, IOPP was non-inferior for outpatient post-cesarean pain management at 1-week post discharge.

Comparison of Intramuscular Versus Rectal Diclofenac Sodium in Post Caesarean Pain Relief

Objective: To compare the mean post-operative pain after intramuscular versus rectal Diclofenac Sodium in post-caesarean patients.&#x0D; Study Design: Quasi-experimental study.&#x0D; Place and Duration of Study: Department of Obstetrics &amp; Gynaecology, Benazir Bhutto Hospital, Rawalpindi Pakistan, from May to Nov 2017.&#x0D; Methodology: A total of 60 women, aged 18-45years, undergoing elective caesarean section were selected. Patients in Group-A were given, Diclofenac 75mg intramuscularly in the gluteal area every 8 hours, while patients in Group-B received a Diclofenac Sodium suppository every 8 hours post-operatively. All patients were followed for pain post-operatively, and final post-caesarean pain was noted at 24 hours post-operatively using a visual analogue scale.Results: The mean age of patients in the Group-A was 29.27±4.68 years, and in Group-B was 30.57±4.80years. The range of gestational age in the study was from 37 to 41 weeks, with an average age of 39.07±1.26 weeks. Mean post-operative pain in Group-A (Intramuscular Diclofenac Sodium-Group) was 1.13±0.43 minutes, whereas in Group-B (Rectal Diclofenac SodiumGroup), was 2.16±0.83 (p-value = 0.001).&#x0D; Conclusion: Mean post-operative pain after using intramuscular Diclofenac sodium is less than Diclofenac Sodium administered rectally in post-operative patients in caesarean sections.

Comparison of Post-Cesarean Pain Perception of General Versus Regional Anesthesia, a Single-Center Study.

Background and Objectives: Pain during and after the procedure remains the leading concern among women undergoing cesarean section. Numerous studies have concluded that the type of anesthesia used during a cesarean section undoubtedly affects the intensity and experience of pain after the operation. Materials and Methods: This prospective cohort study was conducted at the Clinic for Gynecology and Obstetrics, Clinical Center "Dragisa Misovic-Dedinje", Belgrade, Serbia. Patients at term pregnancy (37-42 weeks of gestation) with an ASA I score who delivered under general (GEA) or regional anesthesia (RA) by cesarean section were included in the study. Following the procedure, we assessed pain using the Serbian McGill questionnaire (SF-MPQ), Visual Analogue Scale (VAS) and the pain attributes questionnaire at pre-established time intervals of 2, 12, and 24 h after the procedure. Additionally, time to patient's functional recovery was noted. We also recorded the time to the first independent mobilization, first oral intake, and lactation establishment. Results: GEA was performed for 284 deliveries while RA was performed for 249. GEA had significantly higher postoperative sensory and affective pain levels within intervals of 2, 12, and 24 h after cesarean section. GEA had significantly higher postoperative VAS pain levels. On pain attribute scale intensity, GEA had significantly higher postoperative pain levels within all intervals. Patients who received RA had a shorter time to first oral food intake, first independent mobilization, and faster lactation onset in contrast to GEA. Conclusions: The application of RA presented superior postoperative pain relief, resulting in earlier mobilization, shorter time to first oral food intake, and faster lactation onset in contrast to GEA.

Use of Scheduled Nonopioid Analgesia to Decrease Inpatient Opioid Consumption After Scheduled Cesarean Birth

ObjectiveTo compare opioid use and pain scores in women who had scheduled cesarean birth before and after implementing a scheduled nonopioid analgesia practice guideline. DesignQuality improvement project with a comparison of pre-/postintervention. Setting/Local ProblemA 170-bed community hospital where the administration of postcesarean pain medications was unstandardized. ParticipantsConvenience sample of 175 individuals who were scheduled for cesarean birth (106 in preintervention group and 69 in postimplementation group). Intervention/MeasurementsAll participants had received a dose of 150 mcg of intrathecal morphine intraoperatively. Care of participants in the postimplementation group included a new practice guideline using preoperative oral acetaminophen 1 g and postoperative intravenous ketorolac 30 mg that transitioned to ibuprofen 600 mg orally every 6 hours until discharge. Acetaminophen 1 g every 6 hours also continued until discharge. For breakthrough pain, oxycodone 5 mg to 10 mg was available. ResultsResults were analyzed using the chi-square and t test. There was a statistical difference in the mean milligram morphine equivalent consumed after scheduled cesarean birth (preintervention = 21.15 vs. postintervention = 3.91, p < .001). Postimplementation, 84.1% of participants did not consume any opioids beyond the intrathecal dose compared to 47.2% of participants preintervention. Mean pain scores decreased from 2.49 to 1.62 (p < .001), and there was an observed decrease of the highest reported pain score from 5.39 to 4.03 (p < .001). ConclusionThe results of this project support the current literature indicating that the administration of a scheduled nonopioid multimodal analgesia regimen to individuals with scheduled cesarean birth is an effective postoperative pain management strategy. This approach to managing surgical birth pain can decrease subjective reports of pain and overall opioid consumption during the hospital stay.

Post-operative pain and associated factors after cesarean section at Hawassa University Comprehensive Specialized Hospital, Hawassa, Ethiopia: A cross-sectional study

BackgroundThe most frequent obstetric surgery both in Ethiopia and around the world is the cesarean section (CS). Postoperative pain that is not well managed can have a major negative impact on surgical patient morbidity, delaying healing and the return to normal daily activities. Even though the cesarean section is one of the most commonly performed operations, postoperative pain after cesarean section and associated factors has not been studied. ObjectiveTo assess the magnitude and factors associated with postoperative pain after cesarean section at Hawassa University Comprehensive Specialized Hospital, Hawassa, Ethiopia. MethodsFrom February 1 to September 30 in 2021, a hospital-based cross-sectional study was undertaken among women who underwent cesarean deliveries at Hawassa University Comprehensive Specialized Hospital. The patient's medical file was read, and information was gathered from them using a structured questionnaire and checklist. The information was prepared for analysis by being cleaned, coded, and put into EPI Data version 3.1 before being exported to SPSS version 20. The prevalence rate and socio-demographic details were displayed using descriptive statistics. Bivariate and multivariable logistic regression analysis was done to identify the associated factors. Variables with a p-value of <0.05 were considered statistically significant. ResultsThe magnitude of moderate to severe post-operative pain after a cesarean section was 89.8% (95% CI 84.7, 93.5). Duration of procedure (AOR: 3.62, 95% CI: 1.33, 15.85), type of anesthesia (AOR: 2.38, 95% CI: 1.31, 8.71), and type of analgesics administered (AOR: 2.3, 95% CI: 1.28, 19.21) were significantly associated with moderate to severe post-operative pain. ConclusionIn this study a significant number of parturient in this study reported moderate to severe post-cesarean pain within 24 h. The duration of the procedure, the type of anesthesia used, and the type of analgesics administered were all found to be significantly associated with postoperative pain after cesarean section.

Effectiveness of auricular point acupressure with magnetic plate for pain management in acute postpartum cesarean section patients in Thammasat University Hospital: a randomized clinical controlled trial.

To compare the effectiveness of auricular acupressure with or without magnetic plates to routine post cesarean pain management. This randomized controlled trial was conducted at Obstetrics and Gynecology Department, Thammasat University Hospital, between January and June 2020. All participants were term primigravida pregnant women who underwent cesarean delivery during the study period. Participants were divided into three groups, namely control, placebo and study groups. Study (magnetic application) and placebo (non-magnetic application) groups received magnetic and non-magnetic auricular patches at both pinnas, respectively. Randomized assignments for each group were computer-generated, printed and kept in opaque sealed envelopes. The points in this study were Shenmen (TF4), Erzhong (HX1) and Penqiang (TF5). Visual analog scale (VAS) was immediately recorded up to 72 h after the operation. A total of 195 cases were enrolled during the period of study. Each group had 65 participants. The mean participant's age was 31 years old. Demographic and clinical characters among the three groups were comparable. Pain scores within 12 h postoperative period of all three groups were comparable. Between 36 and 72 h post-operation, study groups had significantly lower VAS than the control group. One-quarter of participants had comparable nausea and vomiting side effects. Auricular acupressure at Shenmen (TF4), Penqiang (TF5) and Erzhong (HX1) with magnetic plate attachment could significantly relieve post cesarean pain between 18 and 72 h.

The effect of aromatherapy and Su Jok interventions on post-cesarean pain

ObjectiveThe aim of this study was to determine the effect of aromatherapy and Su Jok interventions as nonpharmacological methods of relieving pain after cesarean section. Materials and methodsThis randomized controlled trial was conducted with 120 women who had cesarean delivery in the gynecology and obstetrics department of a training and research hospital between February 9 and October 2, 2019. The participants were allocated to the aromatherapy group, Su Jok group, Su Jok and aromatherapy group, or control group using block randomization based on parity. Su Jok was performed using buckwheat seed; aromatherapy was applied using lavender, eucalyptus, or rose oil. Data were collected using a participant information form and pain was assessed using the Visual Analog Scale. ResultsThere was no significant difference between the groups in mean pain levels before or after the intervention, although the control group had less initial pain compared to the intervention groups. However, all three intervention groups showed significant decreases in pain levels immediately and 30 min after the intervention compared to pre-intervention levels (p < 0.05). The intervention in all three groups reduced the level of pain. In particular, the pain level of the Su Jok group reached from moderate to mild. There was no significant change in the control group. ConclusionsAromatherapy and Su Jok interventions performed separately and simultaneously in addition to routine hospital care were more effective in reducing post-cesarean pain than routine care alone.

Post-Caesarean Pain on Maternal Quality of Life

Background: Caesarean section (CS) is one of the commonest interventions that women go through during their fertile period. Over the past 30 years rate of CS use has increased by 10-15%. Moreover both acute and chronic pain after the caesarean section may hamper the patient quality of life and newborn’s care. Post-partum quality of life is an important concept. It has mingled with an individual’s physical health, mental state, independence, social contacts, and personal beliefs. Many quality-of-life scoring tools have been used on patients after CS to measure the post-operative health status and outcome.Methods: This narrational review was outlined by searching MEDLINE databases such as- Google Scholar and PubMed. Selected keywords were searched to identify articles. Randomized Controlled Trials, Observational Studies, Case control and Systemic reviews were included.Conclusion: Post-caesarean pain management is prioritized by women after a caesarean section.

Ultrasound-guided transversalis fascia plane block versus wound infiltration for both acute and chronic post-caesarean pain management - A randomised controlled trial.

Background and Aims:Ultrasound-guided transversalis fascia plane block (USG-guided TFPB) has recently been evaluated for post-caesarean acute pain management. We compared it with standard wound infiltration for both acute and chronic post-caesarean pain management.Methods:All patients undergoing caesarean section (CS) under subarachnoid block were included and randomised. Patients in group C received standard wound infiltration (20 ml of 0.375% ropivacaine) and group-T received bilateral USG-guided TFPB (20 ml of 0.375% ropivacaine) at the end of the surgery. Acute pain assessed using numeric rating scale (NRS), time to first request of analgesia and total rescue analgesic consumption in 24 hours. The incidence of chronic persistent post-surgical pain (CPSP), neuropathic pain component and quality of life (QoL) were assessed. Fisher’s exact test, Chi-square test, unpaired Student’s t-test and Mann-Whitney U test were used.Results:Sixty patients were included with 30 in each group. NRS score on rest at 6th and 24th hour and on active movement at 1st hour was significantly decreased in group T. The “time to first request of analgesia” was statistically higher in group T, that is, 10.77 ± 1.39 h versus 6.30 ± 1.60 h. Five (16.6%) and two (6.6%) patients in groups C and T, respectively, required rescue analgesia in first 24 hours. 30% (n = 6) and 10% (n = 2) patients in groups C and T, respectively, developed CPSP. The neuropathic pain component was significantly reduced and QoL was significantly improved in group T.Conclusion:TFPB is efficacious for management of both acute and chronic post-caesarean pain management.

Acupuncture Safe and Effective to Manage Postcesarean Pain.

According to this study: Preoperative use of acupuncture is safe, has a clinically relevant effect on pain, and accelerates patient mobilization after a cesarean delivery.

Enhanced Recovery after Surgery Protocol to Improve Racial and Ethnic Disparities in Postcesarean Pain Management.

The objective of this study was to assess the efficacy of an enhanced recovery after surgery (ERAS) protocol and determine its effect on racial/ethnic disparities in postcesarean pain management. We performed an institutional review board-approved retrospective cohort study of scheduled cesarean deliveries before and after ERAS implementation at a single urban academic institution. Pre-ERAS, all analgesic medications were given postoperatively on patient request. The ERAS protocol included preoperative acetaminophen and celecoxib. Postoperatively, patients received scheduled nonsteroidal anti-inflammatory drugs and acetaminophen. Oral oxycodone was available as needed, and opioid patient-controlled analgesia was eliminated from the standard order set. The primary outcome was total opioid use in the first 48 hours after cesarean, pre- and post-ERAS, reported in total milliequivalents of intravenous morphine (MME). A secondary analysis of opioid use and pain scores by racial groups was also performed. Chi-square, independent t-tests, analysis of variance, Mann-Whitney U, and Kruskal-Wallis tests were used depending on variable and data normality. Pre-ERAS and post-ERAS groups included 100 women each. Post-ERAS, total opioid use in 48 hours was less (40.8 vs. 8.6 MME, p < 0.001) and visual analog scale (VAS) pain scores were lower on postoperative day 1 (POD1) and 2 (POD2) (POD1 maximum at rest: 6.7 vs. 5.3, p < 0.001). Pre-ERAS pain scores differed by race with non-Hispanic Black (NHB) patients reporting the highest mean and max VAS pain scores POD1 and POD2 (POD1, maximum VAS at rest: NHB-7.4, non-Hispanic White-6.6, Hispanic-5.8, Asian-4.4, p = 0.006). Post-ERAS, there were no differences in postoperative pain scores between groups with movement on POD1 and POD2. A standardized ERAS protocol for postcesarean pain decreases opioid use and may improve some racial disparities in postcesarean pain control. · ERAS protocols improve postoperative pain control and lower postoperative opioid use.. · Studies show that there are racial and ethnic disparities in postpartum pain control.. · Protocols standardize care and may decrease the effects of provider implicit bias..

Analgesia After Cesarean Delivery in the United States 2008-2018: A Retrospective Cohort Study

(Anesth Analg. 2021;133:1550–1558) Multimodal, opioid-sparing analgesia is currently recommended for postcesarean pain management in the United States. These regimens combine neuraxial morphine, scheduled nonsteroidal anti-inflammatory drugs (NSAIDs) and scheduled acetaminophen. Recent studies have supported the use of scheduled acetaminophen plus opioids on an as-needed basis rather than acetaminophen-opioid combination drugs. This study aimed to investigate analgesia following cesarean delivery under neuraxial anesthesia in the United States and examine variations in analgesic regimens over time and between institutions.

Psychosocial Factors of Post-operative Pain Intensity in Women Undergoing Cesarean Section

Background: Little evidence has noted that psychological factors are risk factors of post-operative pain intensity in women undergoing cesarean section. Objectives: The aim of study was to determine predictive psychosocial factors for post-cesarean pain intensity using assessment of depression, anxiety, self-efficacy, and quality of relationship. Methods: This prospective descriptive-analytic study was carried out on 150 healthy women scheduled for cesarean section under spinal anesthesia. The day before the surgery, the patients completed three questionnaires including Hospital Anxiety and Depression Scale (HADS), and General Self-efficacy. Also, 24 hours after the surgery, the intensity of pain in the patients was assessed with filling McGill Pain Questionnaire (MPQ). Linear regression was used to predict the factors of pain intensity. Results: The anxiety was a positive predictor of pain intensity of women after C-section (β = 0. 0.22, P = 0.014). However, depression score, and self-efficacy were not predicting factors of pain intensity of women after C-section. Conclusions: Preoperative anxiety increases post-operative pain intensity in women undergoing cesarean section.

Post-cesarean section analgesia.

Worldwide, the most performed surgical intervention is cesarean section. Hence, post-cesarean pain is a common problem with significant health and economic impact on the individual patient and society. Adequate treatment of post-cesarean pain is necessary to facilitate enhanced recovery, improve neonatal outcome by improving breastfeeding success and bonding between mother and child, and reduce pain-induced side effects. Therefore, optimal pain relief is important, but in the obstetric population, this is often complex due to the interplay of mother and neonate. To facilitate recovery and temper the side effects of potent analgesic drugs such as opioids, multimodal analgesia is currently advocated, and clear international guidelines and recommendations have recently been described. In the present overview, we will discuss the most recent guidelines and evaluate various analgesic interventions.

Effect of Benson’s relaxation therapy on pain and sleep quality among post-cesarean mothers

Aim The aim of the current study was to evaluate the effect of Benson’s relaxation therapy (BRT) on pain and sleep quality among post-cesarean mothers. Design A quasi-experimental design with the pretest and posttest control group design was used. Setting This study was conducted at postpartum wards at Mansoura University Hospital, Egypt. Subjects The purposive sample consisted of 62 post-cesarean mothers on their first and second postoperative days, who were divided into intervention and control groups of 31 participants each. Tools Structured interview schedule, visual analog pain scale to assess pain intensity, and Groningen sleep quality scale to assess sleep quality were used for collecting data. Results There was no statistically significant difference between the studied groups concerning their general characteristics. Nevertheless, a statistically significant reduction was found in the mean of post-cesarean pain score for the intervention group compared with the control group by 5.09±0.94 versus 7.03±0.66 on the second day and 2.42±1.09 versus 5.32±0.75 on the third day, respectively. Moreover, the quality of sleep improved on the second and third day postoperatively with highly statistically significant difference, whereas the mean score on the second day was 5.03±3.58 versus 8.87±4.17 compared with 2.26±2.48 versus 6.03±4.13 on the third day, respectively. Furthermore, a positive correlation was found between pain intensity and quality of sleep. Conclusion It was evident that BRT is an effective and safe method and have a positive effect in reducing pain intensity and improving quality of sleep among post-cesarean mothers. Recommendations Integrating BRT in the protocol of nursing for the care of post-cesarean section mothers.