Impact of post-cesarean section pain management on patient’s satisfaction at Rwanda Military Hospital. A cross-sectional study

Abstract

Background: Pain is a global health problem and can lead to poor health outcomes. In the postoperative period, timely and accurate pain assessment is a prerequisite to effective pain management. Gaps in assessment and management of pain especially during childbearing are important in LMIC and this may lead to dissatisfaction of clients on care received. Objectives: To evaluate the current practice of post-Cesarean pain management and its impact on patient’s satisfaction at RMH. Methodology: A prospective cross-sectional study was conducted from May 2020 to October 2020 at RMH. Parturients aged over 18 years who underwent C-section were enrolled prior to surgery and followed up within the first 24 hours postoperatively. Dichotomous level of satisfaction was compared in regard to pain intensity metrics among study participants. Results: During the data collection, 385 parturients participated in the study. The majority of participants (51.7%) were aged between 26-33 years. Spinal anesthesia was performed in 93.8% of cases, whereas 6.2 % underwent general anesthesia. More than half of cases (n=201; 52.3%) were elective. Intrathecal fentanyl was used in 92.2% of spinal anesthesia. In post-operative period, IM Diclofenac injection was also given in 93.5% of cases and paracetamol in 84.4% of cases. Patients who received intravenous morphine were significantly satisfied (44% vs. 22.8%; p ˂0.001). Using numerical rating scale, majority of patient (n= 347; 90.1%) had low pain scores of less than 3 out of 10 within 24hrs after postoperative pain management. The majority (n=293; 76.1%) of mothers were satisfied with their postoperative pain management. Conclusion: The use of intrathecal fentanyl associated with the use of intravenous paracetamol and intramuscular injection of diclofenac provided a good pain management after C-section. The additional of intravenous morphine was statistically effective in postoperative pain management in Rwanda Military Hospital.