Tailored postoperative treatment plan for women at high risk for severe pain after cesarean delivery

Nearly one third of children in the U.S. are born by cesarean delivery, a surgery that puts women at risk for persistent pain and postpartum depression. A new study presented at ANESTHESIOLOGY 2011 investigated whether an increase in pain treatment in patients at high risk for severe pain after surgery reduces these complications after a cesarean delivery.

Researchers at Wake Forest University School of Medicine preoperatively administered a questionnaire to women scheduled for a pre-planned, non-emergent cesarean delivery to help identify those at risk for severe pain after surgery.

Fifty-three participants who were expected to have severe pain after cesarean delivery, based on a simple questionnaire, were randomly selected to either receive a standard dose of long acting spinal morphine plus oral placebo tablets or a higher dose of long acting spinal morphine plus oral acetaminophen tablets. In addition, all patients received oral ibuprofen and intravenous morphine through a patient controlled pump.

Participants were assessed 24 hours after surgery for pain and at two months for chronic pain and postpartum depression. Findings showed that patients who received the larger dose of spinal morphine plus oral acetaminophen had significantly lower pain scores in the first 24 hours after a cesarean delivery than patients in the other treatment group without an increase in side effects. However, postpartum depression and pain two months later was not different between the two groups.

"Through the use of a very brief questionnaire, we were able to identify which women were at high risk for severe pain after a cesarean delivery," said lead study author Jessica L. Booth, M.D. "We were then able to tailor a postoperative pain treatment plan for these women using simple methods to improve the amount of pain in the days following this major abdominal operation."

Source American Society of Anesthesiologists