National survey of postoperative pain control after cesarean delivery

Sharon Orbach-Zinger*, Alexander Ioscovich, Amir Aviram, Sergei Babytz, Shai Fein, Alon Reuveni, Leonid A. Eidelman

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Postoperative pain is a common problem after cesarean deliveries. Objectives: 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 patientcontrolled 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.

Original languageEnglish
Pages (from-to)153-156
Number of pages4
JournalIsrael Medical Association Journal
Volume16
Issue number3
StatePublished - Mar 2014

Keywords

  • Cesarean delivery (CD)
  • Intrathecal morphine (ITM)
  • Non-steroidal anti-inflammatory drugs (NSAIDs)
  • Obstetric anesthesiology
  • Postoperative pain

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