Title: Post Cesarean-Section Pain Management

Abstract

Background: Post-operative pain management for cesarean section (c-section) is a topic worth investigating to create the best policy to care for recovering new mothers. Women undergoing c-section leave the procedure not only with a new infant to take care of, but also a need to recover their bodies. Opioids have been an effective method for pain management, but with severe side effects such as nausea, vomiting, respiratory depression, physical dependence, and tolerance. Alternative or supplementary pain management methods can help to alleviate pain and aid new mothers to decrease usage and dependence on opioids as well as to decrease hospitalizations. Forming a new policy around post-cesarean section pain management could be beneficial in streamlining and easing the anxiety and pain of new mothers.

Purpose: This project was completed in collaboration with Denver Health and Regis Loretto Heights School of Nursing Honors Nursing Students. This evidence-based project (EBP) aimed to investigate existing research for a policy update at Denver Health. The EBP PICO question was: In post-c-section women , how does opioid pain management compared with non-opioid pain management options including Low-Level Laser Therapy (LLLT) and acetaminophen affect pain?

Learner Outcomes/Objective : The learner will identify two alternative methods to opioids supported by the evidence that alleviate pain for post cesarian-section mothers.

Methods: The research databases searched were CINAHL, Cochrane Library, and Pub Med. The[ZLS6] key words searched were “acetaminophen AND c-section,” “ibuprofen AND c-section,” “LLLT or Low-level laser Therapy,” “Photobiomodulation.” Ten articles published between the years of 2016 to 2020 were chosen to use within the evidence-based project based on the level and quality of evidence.

Results: Articles were appraised using critical appraisal tools. Key findings revealed that in the first 24 hours after surgery, the difference between opioids and nonopioids directly, opioids provided better pain management than nonopioids. Looking at outpatient post-c-section pain scores, non-opioid using patients reported lower pain scores and fewer side effects than the opioid group. Patients who were on a scheduled regimen of non-opioid pain management with as needed opioid had the lowest pain scores compared to just opioid use or just non-opioid use and had lower opioid usage overall. LLLT can reduce pain, inflammation, and promote healing. Other utilizations of LLT include tibia fractures, periodontal procedures, episiotomies, and hernias. Three of 10 articles demonstrated the effectiveness of LLLT with post-Cesarean pain. LLLT was also positively acknowledged by patients as it is non-invasive and did not cause any side effects in any of the resource. Varied use of LLLT revealed its effectiveness may depend on different parameters, however more research is needed to understand the benefits of LLLT.

Implications for Practice: The recommendation to Denver Health was to consider providing post-c-section patients with a scheduled regimen of a non-opioid analgesic with a PRN opioid order for breakthrough pain and to offer nonpharmacologic pain management options such as LLLT if feasible. These alternatives have the potential to lower new mothers’ pain scores and lower overall usage.