In this study of a mixed clinical patient population, we found inadequate pain relief in 34 of 50 patients (68 %) after caesarean section, despite the fact that 47 of the patients had received standard multimodal pain prophylaxis.
In 49 patients, extra opioids were administered on an as-needed basis. This can be interpreted as indicating that patients were not opposed in principle to receiving additional opioid pain relief, as could be hypothesised out of concern over implications for breastfeeding or bonding with the newborn.
Spinal opioids may contribute to nausea and in particular to pruritus (3, 4), which was the most common adverse effect in our dataset.
Seventy per cent of patients reported a low degree of mobilisation on postoperative day one. This may be due to inadequate pain relief, but other possible explanations include fatigue and a desire for rest, or possibly wound guarding or a fear of activity-related pain (5).
One limitation of the study is that 40 % of the patients who were considered for inclusion were excluded because they spoke another language or because they were not in in the department. It is possible that the latter group may have had greater mobility and less pain than the patients who were included, which may have led to our results overestimating the proportion of patients with inadequate pain relief. Furthermore, a dataset comprising 50 patients must be considered small.
There are also drawbacks associated with use of the NRS scale to assess the quality of pain relief. Patients may have differing impressions of what a given score should mean (1, 6).
The results led us to conclude that pain relief after acute and elective caesarean sections was inadequate. As a result of the study, the department in question increased the standard dosage of ibuprofen to 600 mg × 4. In addition, peri-operative dexamethasone 16 mg intravenously was added to the multimodal regimen; this has been shown to provide enhanced nausea and pain prophylaxis (7). Use of post-operative epidural pain relief was also increased in patients with an indwelling epidural catheter from an attempted vaginal delivery.