Influence of multimodal analgesia on maternal independent personal hygiene, newborn care and breastfeeding after cesarean delivery

A retrospective cohort study

Authors

  • Uroš Višič University Medical Centre Ljubljana, The Division of Gynaecology, Šlajmerjeva 3, 1000 Ljubljana, Slovenia https://orcid.org/0000-0002-9563-6903
  • Tatjana Stopar- Pintarič University Medical Centre Ljubljana, The Division of Surgery, Department of Anaesthesiology and Surgical Intensive Care, Zaloška 2, 1000 Ljubljana, and University of Ljubljana, Faculty of Medicine, Institute of Anatomy, Korytkova 2, 1000 Ljubljana, Slovenia https://orcid.org/0000-0003-2750-5386
  • Iva Blajić University Medical Centre Ljubljana, The Division of Surgery, Department of Anaesthesiology and Surgical Intensive Care, Zaloška 2, 1000 Ljubljana, Slovenia https://orcid.org/0000-0003-0413-0999
  • Tit Albreht National institute of Public Health Trubarjeva 2, 1000 Ljubljana, Slovenia https://orcid.org/0000-0002-1812-4381
  • Miha Lučovnik University Medical Centre Ljubljana, The Division of Gynaecology, Šlajmerjeva 3, 1000 Ljubljana, Slovenia https://orcid.org/0000-0003-2708-9175

DOI:

https://doi.org/10.14528/snr.2022.56.3.3137

Keywords:

pain, childbirth, nursing interventions, analgesia, breastfeeding

Abstract

Introduction: The objective of the study was to evaluate whether introducing multimodal analgesics after caesarean delivery can reduce doses of opioids and speed up post-operative recovery.
Methods: We performed a retrospective cohort study comparing two groups: experimental (after introducing a new analgesics regime) and control group (before introducing a. new analgesics regime) We observed patients' ability to independently care for personal hygiene, care for the newborn after cesarean delivery and time from the operation to the first attemot to breastfeed. Chi-square test and Mann-Whitney U test were used as part of the statistical methods for comparison.
Results: Quadratus lumborum block group included 58 patients. After the introduction of the multimodal analgesic regimen, a higher proportion of patients took care of their personal hygiene after 6 hours after cesarean section (44 (76%) patients in the group of quadratus lumborum block and 0 in the group of opioid analgesia). After 12 hours, the share of personal hygiene care in the group where pain was relieved with opioid analgesia slightly improved (55 (95%) in the first group and 28 in the control group (48%, p < 0.001). The first attempt to breastfeed after cesarean section was more frequent in the first hour after surgery in the control group (19 patients in group of quadratus lumborum block (33%) and 32 patients in group with opioid analgesia (55%, p = 0.02). After two hours no differences were detected.
Discussion and conclusion: Multimodal analgesic approach after caesarean delivery allows women to start independently caring for themselves and their newborns quicker, which can help them to adapt to their new role faster.

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References

Abdulkhalikova, D., Trojner Bregar, A., & Premru Sršen, T. (2016). Slovenska priporočila za vaginalni porod po carskem rezu. Zdravniški Vestnik, 85(1), 244−256. https://doi.org/10.6016/ZdravVestn.1512

ACOG Committee Opinion. No. 742 Summary. (2018). Postpartum pain management. Obstetric Gynecology, 132, 252–253. https://doi.org/10.1097/AOG.0000000000002683

Balatero, J., Spilker, A., & McNiesh, S. (2019). Barriers to skinto-skin contact after caesarean birth. The American Journal of Maternal/ Child Nursing, 44(3), 137−143. https://doi.org/10.1097/NMC.0000000000000521 PMid:31033584

Bornstein, E., Husk, G., Lenchner, E., Grunebaum, A., Gadomski, T., Zottola, C. … Chervenak, F. (2021). Implementation of a

standardized post-cesarean delivery order set with multimodal combination analgesia reduces inpatient opioid usage. Journal

of Clinical Medicine, 10(1), 1−10. https://doi.org/10.3390/jcm10010007 PMid:33375192; PMCid:PMC7793107

Brady, K., Bulpitt, D., & Chiarelli, C. (2014). An interprofessional quality improvement project to implement maternal / infant skin-to-skin contact during cesarean delivery. Journal of Obstetrics, Gynecologic & Neonatal Nursing, 43(4), 488−496. https://doi.org/10.1111/1552-6909.12469 PMid:24981767; PMCid:PMC4491370

Eisenach, J., Pan, P., Smiley, R., Lavand'homme, P., Landau, R., & Houle, T. (2009). Severity of acute pain after childbirth, but not type of delivery, predicts persistent pain and postpartum depression. Pain, 140(1), 87−94. https://doi.org/10.1016/j.pain.2008.07.011 PMid:18818022; PMCid:PMC2605246

European Perinatal Health Report. (2018, November). Core indicators of the health and care of pregnant women and babies in Europe in 2015. Retrieved April 24, 2021 from https://www.europeristat.com/images/EPHR2015_Euro-Peristat.pdf

Food and Drug Administration (2017, April, 20). FDA Drug Safety Communication: FDA evaluating the risks of using the pain medicine tramadol in children aged 17 and younger. Retrieved April 24, 2021 from https://www.fda.gov/drugs/drug-safety-andavailability/fda-drug-safety-communication-fda-evaluatingrisks-using-pain-medicine-tramadol-children-aged-17

Herdman T., Kamitsuru S., Lokar k., Bradač H., Cafuta A., Mihelič Zajec A. … Rebec D. (2019). Negovalne diagnoze: definicije in klasifikacija NANDA 2018-2020, (pp. 12-16). Ljubljana: Zbornica zdravstvene in babiške nege - Zveza strokovnih društev medicinskih sester, babic in zdravstvenih tehnikov Slovenije. Huang, J. (2015). The experience of nursing intervention for cesarean section pregnancy. Journal of Nursing, 4(3), 4−6. https://doi.org/10.18686/jn.v4i3.2

Holland, E., Bateman, B., Cole, N., Taggart, A., Robinson, L., Sugrue, R. … Robinson, J. (2019). Evaluation of a quality improvement intervention that eliminated routine use of opioids after cesarean delivery. Obstetrics & Gynecology, 133(1), 91−97. https://doi.org/10.1097/AOG.0000000000003010 PMid:30531571

Jin, J., Sturza, M., Maguire, S., Waljee, J., Smith, R., & Peahl, A. (2021). Nurses' experiences with implementation of a postecesarean birth opioid - sparing protocol. The American Journal of Maternal/ Child Nursing, 46(2), 110−115. https://doi.org/10.1097/NMC.0000000000000694 PMid:33315633

Kodeks etike v zdravstveni negi in oskrbi Slovenije (2014). Ljubljana: Zbornica zdravstvene in babiške nege Slovenije – Zveza strokovnih društev medicinskih sester, babic in zdravstvenih tehnikov Slovenije Kostnapfel, T., & Hočevar Grom, A (2019). Razširjenost predpisovanja opioidov v Sloveniji. ISIS, 11, 38–42.

Pavel, N. (2016). Šest področij v porodni sobi za boljšo porodno prakso (magistrsko delo). Univerza v Mariboru, Fakulteta za zdravstvene vede, Maribor. Retrieved April 24, 2021 from https://dk.um.si/IzpisGradiva.php?lang=slv&id=59851

Schoenwald, A., Windsor, C., Gosden, E., & Douglas, C. (2018). Nurse practitioner led pain management the day after cesarean

section: A randomized controlled trial and follow-up study. International Journal of Nursing Studies, 78(2), 1−9. https://doi.org/10.1016/j.ijnurstu.2017.08.009 PMid:28965648

Smith, A., Young, P., Blosser, C., & Poole, A. (2019). Multimodal stepwise approach to reducing in-hospital opioid use after

cesarean delivery: A quality improvement initiative. Obstetrics & Gynecology, 133(4), 700−706. https://doi.org/10.1097/AOG.0000000000003156 PMid:30870302

Stopar-Pintarič, T., Blajić, I., Višić U., Žnider, M., Plesničar, A. … Lučovnik, M. (2021). Posteromedial quadratus lumborum block versus wound infiltration after caesarean section: A randomised, double-blind, controlled study. European Journal of Anaesthesiology, 38(2), 128−144. https://doi.org/10.1097/EJA.0000000000001531 PMid:33988528

Višić U., Stopar Pintarič, T., Albreht, T., Blajić, I., & Lučovnik, M. (2021). Multimodal stepwise analgesia for reducing opioid consumption after cesarean delivery. Clinical and Experimental Obstetrics & Gynecology, 48(5), 1162−1166. https://doi.org/10.31083/j.ceog4805186

Wang, L. Z., Wei, C. N., Xiao, F., Chang, X. Y., & Zhang, Y. F. (2018). Incidence and risk factors for chronic pain after elective cesarean delivery under spinal anaesthesia in a Chinese cohort: A prospective study. International Journal of Obstetrics Anaesthesia, 34(1), 21−27. https://doi.org/10.1016/j.ijoa.2018.01.009 PMid:29534950

Wen, J., Yu, G., Kong, Y., Liu, F., & Wei, H. (2020). An exploration of the breastfeeding behaviors of women after cesarean section:

A qualitative study. International Journal of Nursing Science, 7(4), Article 419426. https://doi.org/10.1016/j.ijnss.2020.07.008

PMid:33195754; PMCid:PMC7644566

World Medical Association. (2013). World Medical Association Declaration of Helsinki: Ethical principles for medical research

involving human subjects. Journal of the American Medical Association, 310(20), 2191–2194. https://doi.org/10.1001/jama.2013.281053

Published

2022-09-15

How to Cite

Višič, U., Stopar- Pintarič, T. ., Blajić, I. ., Albreht , T. ., & Lučovnik , M. . (2022). Influence of multimodal analgesia on maternal independent personal hygiene, newborn care and breastfeeding after cesarean delivery: A retrospective cohort study. Slovenian Nursing Review, 56(3), 194–199. https://doi.org/10.14528/snr.2022.56.3.3137

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Original scientific article

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