The prevalence of moderate-to-severe rebound pain after spinal caesarean section at Tygerberg Hospital following new analgesia guidelines implementation

Abstract

Background: A previous study at Tygerberg Hospital identified a 91.7% prevalence of moderate-to-severe rebound pain (Visual Analogue Scale [VAS] ≥ 4 mm) in patients undergoing spinal caesarean section (CS). Since implementing new analgesia guidelines that focus on using intrathecal morphine and administering systemic, multimodal analgesia before spinal offset and discharge to the ward, the prevalence has not been investigated again.

Methods: A retrospective, non-interventional study of 339 patients from the Tygerberg PAIN OUT South Africa (SA) database who underwent CS under spinal anaesthesia was conducted to determine the prevalence of moderate-to-severe rebound pain and allow comparison to the previous study. Patients completed a questionnaire, including a numeric rating scale (NRS), for the worst pain experienced since surgery on postoperative day one. Demographic and therapeutic data were also collected.

Results: The questionnaire was completed by 99% of the obstetric patients in the PAIN OUT SA database. The prevalence (95% confidence intervals [CI]) of moderate-to-severe pain was 83.2% (79.2% to 87.2%) compared to 91.7% (83.8% to 95.9%) in the previous study. For severe pain alone (NRS ≥ 7), the incidence was 46.6% (41.4% to 51.9%) compared to 65.5% (54.8% to 74.7%). The median (interquartile range [IQR]) intensity of the worst pain was 6 (4–8), compared to the median VAS of 85 (66–100) in the previous study. Therapeutic records revealed partial adherence to the new guidelines.

Conclusion: This study found a high prevalence of moderate-to-severe rebound pain after CS under spinal anaesthesia. Despite this, the prevalence of severe pain and the median intensity of pain have declined significantly after implementing new departmental guidelines. The analgesic options recommended by the guidelines were only partially utilised. Departmental guidelines should be visible, easy to follow, and convincingly advocated to have the optimal effect.