Oral painkillers best after C-section

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For acute pain relief after cesarean section, oral pain medication (oxycodone and acetaminophen) appears to be more effective than patient-controlled morphine, doctors found in a head-to-head comparison.

Oral oxycodone-acetaminophen for the treatment of postcesarean pain “offers superior pain relief with fewer undesirable side effects such as nausea and drowsiness for patients and appears to be less expensive and more convenient for providers and hospitals,” the researchers conclude.

Morphine infusions are typically used for pain control after surgery, including patient-controlled analgesia, but narcotics have a number of side effects and the devices used to deliver patient-controlled analgesia can be “cumbersome,” Dr. Kathryn M. Davis and colleagues from the University of Massachusetts Medical School note in the American Journal of Obstetrics and Gynecology.

Davis and her team randomized 93 patients to either oxycodone-acetaminophen or patient-controlled analgesia after C-section. Patients on oral analgesia took two tablets immediately after the surgery and then every 3 hours for 12 hours. In the next 12 hours, patients were allowed one or two tablets every 4 hours for a maximum of 12 tablets over 24 hours. Patients on patient-controlled analgesia received a continuous morphine infusion, with an additional dose available by patient demand, for 12 hours. After 12 hours, these patients were switched to oral analgesia.

At 6 and 24 hours after surgery, patients initially on oral analgesia had less pain and less nausea than those on patient-controlled analgesia. Patients on oral analgesia were also less sedated at 6 hours, but there was no difference between the two groups at 24 hours.

There was also no significant difference between the groups in the frequency of vomiting, intake of fluids or ability to move around.

Based on their findings, the authors suggest that doctors consider expanding the use of oral pain medication immediately after cesarean delivery.

SOURCE: American Journal of Obstetrics and Gynecology, April 2006.

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