Efficacy and Cost of Post Cesarean Pain Management Using the World Health Organisation Recommendations Versus Routine Care at Nyeri County Referral Hospital a Randomized Controlled Trial

Abstract

Background: Adequate postoperative pain control after cesarean section is important because the postoperative mothers need enhanced recovery to effectively take care of their newborns. Effective pain control in the acute period aids early patient mobility and thus reduces the risk of postoperative venous thromboembolism. In addition, adequate postoperative pain control facilitates mother-child bonding and breastfeeding and can shorten hospital stay. Suboptimal acute post-operative pain management usually leads to persistent intermediate plus long post-operative pain, delayed functional recovery and postpartum depression. The World Health Organization (WHO) has issued guidelines/ recommendation on pain management. Pharmacologic management of acute pain is based on the World Health Organization analgesic ladder. Nyeri County Referral Hospital (NCRH) just like the national Ministry of Health in Kenya has not adopted these recommendations. In this study we sought to evaluate the efficacy and cost of WHO recommended versus the current routine post cesarean pain management at NCRH to inform practice decisions. Objective: To evaluate the efficacy and cost of WHO recommended versus the routine care for post cesarean pain management at NCRH. Methodology: This was a single blind Randomized controlled trial that was conducted in NCRH maternity theater and post-natal wards. Patients were randomized into two groups, either the WHO recommended pain management or the routine NCRH care with each having 193 participants. The primary outcomes were adequacy of pain control using the visual analog scale at immediately post-operatively, at 6,12,24 and 72 hours, patient satisfaction on pain control after 72 hours post-operation and cost of medications in each group. Descriptive statistics were used to describe the socio demographic characteristics of the study participants. Adequacy of pain control from the visual analog scale was compared between the two groups using independent T-test. Proportion of pain satisfaction 72 hours post-operatively was done using chi-square test. All statistical tests were performed at 5% level of significance p value<0.05. Cost analysis was done by multiplying the average cost of each medication with the total medications used by patients in each group. This was presented as total cost of pain management in each group. Intention-To-Treat (ITT) analysis was used. Data was analyzed using STATA® analytical package version 13. This study was approved by Kenyatta National Hospital-University of Nairobi Ethics and research committee under..............................................................................................................................