National survey of postoperative pain control after cesarean delivery.
BACKGROUND
Postoperative pain is a common problem after cesarean deliveries.


OBJECTIVE
To characterize common obstetric anesthesia practices after cesarean deliveries in Israel in order to standardize postoperative pain relief protocols.


METHODS
A questionnaire was completed during an interview with every obstetric anesthesia unit in all 25 delivery wards in Israel. Data were gathered on intraoperative anesthesia and analgesia protocols as well as postoperative pain relief protocols. A sub-analysis compared units whose director completed a formal obstetric anesthesia training program with those whose directors did not.


RESULTS
Neuraxial morphine was used routinely in 12% of hospitals. No unit providing intrathecal morphine complied with American Society of Anesthesiologists guidelines for respiratory monitoring after use of neuraxial opioids. Additionally, non-steroidal anti-inflammatory drugs (NSAIDs) .were used routinely in only half the wards, while patient-controlled analgesia was used infrequently. Postoperative verbal analog scores were not recorded routinely in 71% of units on postoperative day 1. The unit director's training significantly influenced the unit protocols.


CONCLUSIONS
Intrathecal morphine, the gold standard of care in cesarean deliveries, is rarely used, mainly due to shortage of staff and lack of formal obstetric anesthesia training. In addition, NSAIDs are also underused. There is a need for more formal training for obstetric anesthesiologists in Israel.
Sharon
S
Orbach-Zinger
Alexander
A
Ioscovich
Amir
A
Aviram
Sergei
S
Babytz
Shai
S
Fein
Alon
A
Reuveni
Leonid A
LA
Eidelman
D016362:Analgesia, Obstetrical / Q000379:methods; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D000773:Anesthesia, Obstetrical / Q000379:methods*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage / Q000627:therapeutic use; D002585:Cesarean Section / Q000379:methods*; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D007278:Injections, Spinal; D007557:Israel; D009020:Morphine / Q000008:administration & dosage*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000517:prevention & control*; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D011795:Surveys and Questionnaires
D000701:Analgesics, Opioid; D000894:Anti-Inflammatory Agents, Non-Steroidal; D009020:Morphine