title: Peri-operative multimodal pain therapy for caesarean section: analgesia and fitness for discharge.
abstract: OBJECTIVE
  To compare, the efficacy of a multi-modal analgesic regimen and single drug therapy with iv PCA morphine alter Caesarean delivery with spinal anaesthesia.
  
  
  METHODS
  Forty ASA 1-2 parturients presenting for elective Caesarean section were randomized to receive multimodal pain treatment with intrathecal morphine, incisional bupivacaine and ibuprofen+acetaminophen po until hospital discharge (Group 1) or conventional therapy with iv PCA morphine weaned to acetaminophen+codeine po (Group 2). Both groups received spinal anaesthesia with 1.7 ml hyperbaric bupivacaine 0.75%. Visual analog pain scores at rest (RVAPS) and with movement (DVAPS) were recorded q 2 hr during the first 24 hr, then q 4 hr until discharge. Time to first walking, eating solid food, flatus, bowel movement, voiding and hospital discharge were recorded.
  
  
  RESULTS
  Pain scores were lower in Group 1 patients during the first 24 hr after spinal injection RVAPS 0.6 +/- 0.1 in Group 1 vs 2.1 +/- 0.1 in Group 2 (mean +/- SEM), DVAPS 1.9 +/- 0.1 in Group 1 vs 4.1 +/- 0.1 in Group 2 (P < 0.0001). Times to first flatus, 36.1 hr +/- 2.9 vs 20.5 +/- 1.8 (P < 0.05) and to first bowel movement, 74.8 hr +/- 5.6 vs 57.4 +/- 4.7 (P < 0.0001) were longer in Group 2 patients. There was no difference between groups in time to eating solid food, walking or hospital discharge.
  
  
  CONCLUSIONS
  Multi-modal pain therapy resulted in improved early post-operative analgesia during the first 24 hr after Caesarean delivery. Patients receiving iv PCA morphine followed by acetaminophen+codeine po were more likely to develop decreased bowel mobility. All patients, with one exception, achieved discharge criteria (eating solid food, absence of nausea, normal lochia, dry incision and DVAPS < 4) at 48 hr after spinal injection.
authors.affiliation: Department of Anaesthesia, Ottawa Civic Hospital, University of Ottawa, Ontario, Canada.
authors.forename: O P
authors.initials: OP
authors.lastname: Rosaeg
authors.forename: A C
authors.initials: AC
authors.lastname: Lui
authors.forename: N J
authors.initials: NJ
authors.lastname: Cicutti
authors.forename: P R
authors.initials: PR
authors.lastname: Bragg
authors.forename: M L
authors.initials: ML
authors.lastname: Crossan
authors.forename: B
authors.initials: B
authors.lastname: Krepski
mesh_terms: D016362:Analgesia, Obstetrical; D016058:Analgesia, Patient-Controlled; D000700:Analgesics / Q000008:administration & dosage*; D000775:Anesthesia, Spinal; D002585:Cesarean Section; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D010351:Patient Discharge; D011247:Pregnancy
chemical_list: D000700:Analgesics