Post-caesarean analgesia: a multicentre retrospective analysis comparing practices in Queensland, Australia...

Optimising post-caesarean analgesia is important to facilitate quality maternal recovery. We described post-caesarean analgesia and patient satisfaction to determine alignment with expert recommendations and described practice changes over time.

This retrospective multisite study included patients undergoing caesarean delivery in public hospitals in Queensland. We evaluated the use of long-acting neuraxial opioid; additional regional analgesia techniques; simple analgesics and "as-required" oral opioids for rescue and patient satisfaction. Differences between the first 6-month and last 7-month periods were compared.

Of 27,867 patients reported between January 2019 and July 2022, 25,531 (91.6%) received neuraxial anaesthesia. Of those, 12 341 (48.3%) received neuraxial morphine/hydromorphone. Regional techniques were more common after general anaesthesia (GA, primary or secondary) compared with neuraxial anaesthesia (adjusted P < 0.001). Paracetamol was used in 27,754 (99.6%) and nonsteroidal anti-inflammatory drugs (NSAIDs) in 26,231 (94.1%). The most common oral analgesia combination was paracetamol, NSAIDs, immediate-release oxycodone and slow-release oxycodone (8035, 30.6%). Of all patients, 25,294 (90.8%) were satisfied/very satisfied and more patients having neuraxial anaesthesia were satisfied/very satisfied (adjusted P < 0.001). Use of long-acting neuraxial opioid increased significantly from 1544 of 3242 (48%) to 2847 of 4307 (66%) during the interval studied (P < 0.001). Use of slow-release oxycodone decreased from 2403 (67%) to 2255 (48%). Buprenorphine use increased from 181 (5%) to 981 (21%) and tramadol from 1299 (36%) to 2258 (48%), all P < 0.001.

Use of long-acting neuraxial opioid and oral atypical opioids increased, while commonly prescribed slow-release opioid declined with time. Compliance with opioid-sparing principles can be significantly improved.