Analgesia provided following caesarean section delivery at fixed time intervals shows improved efficacy in pain and other outcomes, compared with on-demand analgesia, according to a study presented here at The Pregnancy Meeting, the 2015 Annual Meeting of the Society for Maternal-Fetal Medicine (SMFM).
The study involved 187 patients who underwent regional anaesthesia for caesarean section. Following the surgery, the women were randomised to pre-determined combinations of tramadol, paracetamol and diclofenac either at regular intervals, with tramadol and paracetamol every 6 hours and diclofenac every 12 hours (n = 94), or in response to patient demand (n = 93) for the first 48 hours.
There were no significant differences between the groups in terms of baseline characteristics, including visual analogue scale (VAS) pain score.
Patients in the fixed-time interval medication group, however, had significantly lower pain scores immediately before and 1 hour after every administration of analgesia, compared with the on-demand group.
The fixed-time interval group also had higher satisfaction rates, more breastfeeding, and less use of baby formulas. The improvements in infant feeding were likely a result of less pain in the mother.
“Pain is a major obstacle for maternal bonding and breastfeeding,” said Enav Yefet MD, Emek Medical Center, Afula, Israel. “Moreover, if the baby is fed less, then more baby formulas are needed. Since the women experienced reduced pain they could breastfeed more easily and the baby needed less formula.”
Despite the fact that patients in the fixed-time interval group had slightly higher rates in the number of times drugs were administered, they had no higher rates of maternal adverse effects, which were described as mild and included nausea and dizziness. The neonates showed no adverse effects.
The likely reason for the improvement in the fixed-time group is that pain relievers are most effective when provided while pain levels are still low or intermediate, and women in the fixed-time group received pain relievers before the intensity of the pain set in, according to Dr. Yefet.
“Many types of analgesic agents inhibit the production of pain mediators, [but] if the pain becomes intense it implies that those pain mediators have already been synthesised, and at this point pain medications are less effective,” he said.
The women in the fixed-time interval group said they preferred the approach because it removed the burden of anticipating the need for the next dose, he added.
“[They said] it gave them a reassurance that the pain issue is being addressed and they would not need to be preoccupied by the fear to sense severe pain or to pay attention to the timing of the next dose,” said Dr. Yefet.