Fixed-Interval or On-Demand Treatment Better for C-Section Pain?
This study by Yefet et al. (BJOG, 2017) aimed to compare on-demand vs. fixed-interval of oral analgesics following c-section for pain relief, safety and patient satisfaction.
Randomized Controlled Trial (RCT)
200 women who had undergone C-sections with regional anesthesia were randomly assigned to receive predetermined combinations of tramadol (opioid), paracetamol (acetaminophen), and diclofenac (NSAID) either on-demand or every six hours (for the first 48 hours). If greater pain relief was required, Percocet was given as a rescue treatment. Self-evaluation was used to determine pain intensity and satisfaction, visual analog scales of 0 (no pain, least satisfaction) to 10 (worst pain, highest satisfaction). Breastfeeding, need for supplemental formula, and any adverse maternal and neonatal effects were also evaluated. The fixed interval group had lower mean pain scores than the on-demand group (2.8 ± 0.84 vs. 4.1 ± 0.48), as well as higher satisfaction scores (9.1 ± 1.2 vs. 8.3 ± 1.5), more breastfeeds (23.7 ± 6.5 versus 19.2 ± 6.2), and lower uses of formula (8.2 ± 5.2 versus 11.9 ± 6.5). The women in the fixed-interval group did ingest more drugs, but this did not lead to a corresponding increase in serious adverse maternal or neonates outcomes.
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