Universität zu Köln

Marcus, H., Gerbershagen, H. J., Peelen, L. M., Aduckathil, S., Kappen, T. H., Kalkman, C. J., Meissner, W. and Stamer, U. M. (2015). Quality of pain treatment after caesarean section: Results of a multicentre cohort study. Eur. J. Pain, 19 (7). S. 929 - 940. HOBOKEN: WILEY. ISSN 1532-2149

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Abstract

BackgroundA large cohort study recently reported high pain scores after caesarean section (CS). The aim of this study was to analyse how pain after CS interferes with patients' activities and to identify possible causes of insufficient pain treatment. MethodsWe analysed pain scores, pain-related interferences (with movement, deep breathing, mood and sleep), analgesic techniques, analgesic consumption, adverse effects and the wish to have received more analgesics during the first 24h after surgery. To better evaluate the severity of impairment by pain, the results of CS patients were compared with those of patients undergoing hysterectomy. ResultsCS patients (n=811) were compared with patients undergoing abdominal, laparoscopic-assisted vaginal or vaginal hysterectomy (n=2406, from 54 hospitals). Pain intensity, wish for more analgesics and most interference outcomes were significantly worse after CS compared with hysterectomies. CS patients with spinal or general anaesthesia and without patient-controlled analgesia (PCA) received significantly less opioids on the ward (62% without any opioid) compared with patients with PCA (p<0.001). Patients with PCA reported pain-related interference with movement and deep breathing between 49% and 52% compared with patients without PCA (between 68% and 73%; p-values between 0.004 and 0.013; not statistically significant after correction for multiple testing). ConclusionIn daily clinical practice, pain after CS is much higher than previously thought. Pain management was insufficient compared with patients undergoing hysterectomy. Unfavourable outcome was mainly associated with low opioid administration after CS. Contradictory pain treatment guidelines for patients undergoing CS and for breastfeeding mothers might contribute to reluctance of opioid administration in CS patients.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Marcus, H. UNSPECIFIED UNSPECIFIED UNSPECIFIED Gerbershagen, H. J. UNSPECIFIED UNSPECIFIED UNSPECIFIED Peelen, L. M. UNSPECIFIED UNSPECIFIED UNSPECIFIED Aduckathil, S. UNSPECIFIED UNSPECIFIED UNSPECIFIED Kappen, T. H. UNSPECIFIED UNSPECIFIED UNSPECIFIED Kalkman, C. J. UNSPECIFIED UNSPECIFIED UNSPECIFIED Meissner, W. UNSPECIFIED UNSPECIFIED UNSPECIFIED Stamer, U. M. UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-397805
DOI:	10.1002/ejp.619
Journal or Publication Title:	Eur. J. Pain
Volume:	19
Number:	7
Page Range:	S. 929 - 940
Date:	2015
Publisher:	WILEY
Place of Publication:	HOBOKEN
ISSN:	1532-2149
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language ABDOMINIS PLANE BLOCK; RANDOMIZED CONTROLLED-TRIAL; POSTOPERATIVE ANALGESIC REQUIREMENTS; CONTROLLED EPIDURAL ANALGESIA; ENHANCED RECOVERY; POSTCESAREAN PAIN; DELIVERY; ANESTHESIA; MORPHINE; SURGERY Multiple languages Anesthesiology; Clinical Neurology; Neurosciences Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/39780