A Comparison of Two Regimens for Post-Caesarean Section Analgesia in a Tertiary Health Centre in Northern Nigeria

Post-caesarean section pain is a problem i n our environment. Though many modalities for pain management exist, there is the need to investigate safer and affordable regimens that will provide adequate analgesia with minimal side effects and with ease of administration. Alternating doses of intramuscular acetaminophen and intramuscular pentazocine was studied as an alternative to provide safe and effective post-caesarean section analgesia. Its effectiveness and side effect profile in our environment have not been previously investigated.

The study aimed to compare the analgesic and side effect profile of intramuscular pentazocine with another regimen involving alternating doses of pentazocine and acetaminophen within the first 48hours after surgery.

This was a prospective, comparative and randomized study among 142 women who voluntarily consented to the study and had elective caesarean section from May 2014 to May 2015 at the Ahmadu Bello University Teaching Hospital, Zaria. Setting: The Study was conducted at the obstetrics and gynecology department of the teaching hospital of Ahmadu Bello University, Zaria.

Consecutive eligible pregnant women who were slated for elective caesarean section were recruited at the antenatal clinic unit of the department and randomized using the WINPEPI software by Abramson to either receive intramuscular pentazocine or alternating doses of pentazocine and acetaminophen over the first 48hours after surgery. The pain scores, side effect profile and the time taken for the return of bowel sounds were compared among the two groups using relevant statistical methods with IBM SPSS version 20 with Z tests and chi-square to test for strength of relationships of variables. The level of significance was 0.05.

The average age of the participants was 29.82years with standard deviation 6.138; 64.8% were Hausa-Fulani, 71.83% were Muslims, 45.07% were unemployed, 97.89% were married, 42.2% were multiparous, 59.86% booked in our centre and 59.2% were having their first caesarean section. Seventy-six participants received combination of injection pentazocine/acetaminophen while 66 received pentazocine injection alone. The drop-out rate was 8.5%. There was no statistically significant difference in the pain scores both on the visual analogue scale and the verbal rating scale in the first 48hours in both groups, no difference in the need for rescue analgesics (p=0.709), time taken for the return of bowel sounds (P=0.391), incidence of side effects (p=0.394) and participants' level of satisfaction (p=0.255).

Both regimens were comparable in analgesic efficacy, incidence of side effects and satisfaction levels.