Women who have had a Cesarean Section (CS) frequently report severe pain and pain-related interference. One reason for insufficient pain treatment might be inconsistent implementation of evidence-based guidelines. We assessed the association between implementing three elements of care recommended by guidelines for postoperative pain management and pain-related patient-reported outcomes (PROs) in women after CS. The analysis relied on an anonymized dataset of women undergoing CS, retrieved from PAIN OUT. PAIN OUT, an international perioperative pain registry, provides clinicians with treatment assessment methodology and tools for patients to assess multi-dimensional pain-related PROs on the first postoperative day. We examined whether the care included [i] regional anesthesia with a neuraxial opioid OR general anesthesia with wound infiltration or a Transvesus Abdominis Plane block; [ii] at least one non-opioid analgesic at the full daily dose; and [iii] pain assessment and recording. Credit for care was given only if all three elements were administered (= “full”); otherwise, it was “incomplete”. A “Pain Composite Score-total” (PCS_total), evaluating outcomes of pain intensity, pain-related interference with function, and side-effects, was the primary endpoint in the total cohort (women receiving GA and/or RA) or a sub-group of women with RA only. Data from 5182 women was analyzed. “Full” care was administered to 20% of women in the total cohort and to 21% in the RA sub-group. In both groups, the PCS_total was significantly lower compared to “incomplete” care (p < 0.001); this was a small-to-moderate effect size. Administering all three elements of care was associated with better pain-related outcomes after CS. These should be straightforward and inexpensive for integration into routine care after CS. However, even in this group, a high proportion of women reported poor outcomes, indicating that additional work needs to be carried out to close the evidence-practice gap so that women who have undergone CS can be comfortable when caring for themselves and their newborn.

Background and Aims: Effective postoperative pain management is pivotal not only for alleviating discomfort but also for enhancing overall patient satisfaction and recovery. This systematic review aims to investigate various factors influencing patient satisfaction due to the postoperative pain management offered. Methods: Using relevant keywords, we searched PubMed, Scopus, and the Cochrane database after registering the protocol in PROSPERO. A qualitative systematic review was planned using the Appraisal Tool for Cross-Sectional Studies (AXIS tool) to assess the risk of bias (RoB). Thereafter, a quantitative meta-analysis of the transformed proportions was performed using an inverse-variance random-effects model, and a Freeman–Tukey double arcsine transformation was applied to all reported proportions. Results: From the 1234 articles available after the database search, 21 articles comprising 7289 patients met the inclusion criteria. Among the 21 studies, 12 (57.14%) had a moderate RoB, while nine (42.85%) had a low RoB. The random effects model, using the inverse variance method and the Freeman–Tukey double arcsine transformation, revealed a summarised proportion of 0.8 (95% confidence interval: 0.74,0.85), with significant heterogeneity ( P < 0.01 and I ² statistic of 97%). The various factors influencing postoperative patient satisfaction were summarised. Conclusions: Based on the results from this systematic review and meta-analysis, we conclude that the majority of the patients are satisfied with the postoperative pain management offered (a summarised proportion of 0.8 or 80%). Further studies need to be done to find out optimal strategies to improve patient satisfaction undergoing various surgeries. Having robust perioperative pain management policies and an audit of patient satisfaction for pain management could help in improving institutional practices.

The Critical Care Society of Southern Africa Consensus Statement on ICU Triage and Rationing (ConICTri)

Chronic pain affects a significant proportion of the population. It negatively affects wellbeing, quality of life and productivity. To improve the effective management of chronic pain it is essential to understand pain physiology. The aim of this ...

The African Journal of Primary Health & Family Medicine welcomes submissions that encourage scholarly exchange between family medicine and primary health care researchers and practitioners across Africa and the developing world, whilst providing a contextual and holistic view of family medicine as practiced across the continent.