Background and Aims Caesarean sections are associated with moderate to severe pain in the post-operative period.1 Inadequate pain relief may cause delayed recovery, impair mother-child bonding and newborn care, impact maternal psychological well-being,1 and can lead to persistent pain following caesarean section delivery.2
The 2020 PROSPECT guideline for elective caesarean section outlines optimal pain management following elective caesarean sections.3Our aim was to review our own analgesic protocols prior to a quality improvement project to institute compliance with these recommendations. We also evaluated opioid use over a three-year period.
Methods Ethical approval was granted for this audit, allowing for data collection and analysis of 60 anonymised patients (20 each from November of 2019, 2020 and 2021) who underwent elective caesarean section with neuraxial anaesthesia. Data were collected on intra-operative anaesthesia and analgesia, post-operative prescribing and administration of regular paracetamol, NSAID, long-acting opioid, and PRN short acting opioid. Using Excel v.2204 we analysed data from each year to assess for changes in analgesic prescribing.
Results Mean patient age was 36.2 year (±0.7 years), ranging from 23 to 47 years. Median length-of-stay was 4.0 days (± 0.3 days), ranging from 3 to 21 days.
Conclusions While more than 60% of our cohort had appropriate regular adjunct analgesia charted, we found an increase in prescribed long-acting opioid from 24% to 50% from 2019 to 2021. To achieve the framework provided by PROSPECT we have initiated a quality improvement project, with a standardised drug prescription kardex, and an extensive education programme for medical and nursing staff on-site.