Assessment and determinants of acute post-caesarean section pain in a tertiary facility in Ghana.

Autor: Azanu WK; Department of Obstetrics and Gynaecology, School of Medicine, University of Health and Allied Sciences, Ho, Ghana., Osarfo J; Department of Community Medicine, School of Medicine, University of Health and Allied Sciences, Ho, Ghana., Larsen-Reindorf RE; Department of Obstetrics and Gynaecology, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.; Department of Population, Family and Reproductive Health, School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana., Agbeno EK; Department of Obstetrics and Gynaecology, School of Medical Sciences, University of Cape Coast, Cape Coast, Ghana., Dassah E; Department of Population, Family and Reproductive Health, School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana., Amanfo AO; Department of Obstetrics and Gynaecology, School of Medical Sciences, University of Cape Coast, Cape Coast, Ghana., Dah AK; Department of Obstetrics and Gynaecology, School of Medicine, University of Health and Allied Sciences, Ho, Ghana., Ampofo G; Department of Community Medicine, School of Medicine, University of Health and Allied Sciences, Ho, Ghana.
Jazyk: angličtina
Zdroj: PloS one [PLoS One] 2022 May 25; Vol. 17 (5), pp. e0268947. Date of Electronic Publication: 2022 May 25 (Print Publication: 2022).
DOI: 10.1371/journal.pone.0268947
Abstrakt: Introduction: Caesarean sections (CS) feature prominently in obstetric care and have impacted positively on maternal / neonatal outcomes globally including Ghana. However, in spite of documented increasing CS rates in the country, there are no studies assessing the adequacy of post-CS pain control. This study assessed the adequacy of post-CS pain management as well as factors influencing this outcome. Additionally, post-CS analgesia prescription and serving habits of doctors and nurses were also described to help fill existing knowledge gaps.
Methods: Pain scores of 400 randomly selected and consenting post-CS women at a tertiary facility in Ghana were assessed at 6-12 hours post-CS at rest and with movement and at 24-36 hours post-CS with movement using a validated visual analog scale (VAS) from February 1, 2015 to April 8, 2015. Participant characteristics including age, marital status and duration of CS were obtained using pretested questionnaires and patient records review. Descriptive statistics were presented as frequencies and proportions. Associations between background characteristics and the outcome variables of adequacy of pain control at 6-12 hours post-CS at rest and with movement and at 24-36 hours post-CS with movement were analysed using Chi-square and Fisher's exact tests and logistic regression methods. Adequate pain control was defined as VAS scores ≤5.
Results: At 6-12 hours post-CS (at rest), equal proportions of participants had adequate and inadequate pain control (50.1% vrs 49.9%). Over the same time period but with movement, pain control was deemed inadequate in 93% of respondents (369/396). Women who had one previous surgery [OR 0.47 95%CI 0.27, 0.82; p = 0.008] and those whose CS lasted longer than 45 mins [OR 0.39 95% CI 0.24, 0.62; p<0.001] had lower odds of reporting adequate pain control. Women prescribed 12-hourly and 8-hourly doses of pethidine had only 23.5% (12/51) and 10.3% (3/29) served as prescribed respectively. At 24-36 hours post CS, adequate pain control was reported by 85.3% (326/382) of participants.
Conclusions: Pain management was deemed inadequate within the first 12 hours post-CS with potential implications for early mother-child interaction. Appreciable numbers of participants did not have their analgesics served as prescribed. Adjunct pain control measures should be explored and healthcare workers must be encouraged to pay more attention to patients' pain relief needs.
Competing Interests: The authors have declared that no competing interests exist.
Databáze: MEDLINE
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