A hospital-sponsored quality improvement study of pain management after cesarean delivery

Objective: We undertook this study to systematically assess prevailing pain management regimes used at our hospital in women after cesarean delivery. Study design: Between August 1999 and July 2000, all women delivered by cesarean section at Parkland Hospital were assigned to 1 of 4 different pain management strategies: (1) intramuscular (IM) meperidine, (2) patient-controlled analgesia (PCA) meperidine, (3) IM morphine sulfate, and (4) PCA morphine sulfate. A combination of methods were used to compare these different pain management strategies. A survey questionnaire, using Likert scale responses, was administered to evaluate maternal satisfaction with pain control. Visual Analog Scale (VAS) scores and information regarding breastfeeding and rooming-in were also collected. Results: A total of 1256 women were allocated to the 4 analgesia study groups. The median meperidine dosages for the IM and PCA groups were 350 mg and 600 mg, respectively (P ≤ .01). Conversely, the median IM morphine dose (65 mg) was significantly higher than that for the PCA group (60 mg). The percentage of women reporting moderate or worse pain (VAS scores 4 or more) was significantly lower in those women who received PCA meperidine compared with IM meperidine. Women who received morphine reported less severe pain compared with meperidine, regardless of route of administration. The patients' subjective report of satisfaction with pain management was not related to the method or drug used for pain control (P = .13). Fewer women assigned to morphine therapy stopped breastfeeding (P = .02) and more roomed-in with their infants (P < .01). Conclusion: Pain relief was superior with the morphine regimens used and was positively associated with breastfeeding and infant rooming-in.