Postpartum pain management for women undergoing cesarean sections using a multimodal pain control protocol: a...

Cesarean section is one of the most common major abdominal surgeries performed in the world. The American College of Obstetricians and Gynecologists (ACOG) states that untreated maternal pain after Cesarean delivery is associated with greater opioid use, postpartum depression, and the development of chronic pain. Enhanced Recovery After Cesarean (ERAC) is a multidisciplinary approach to managing postpartum pain. It is proven to not only reduce postpartum pain scores, but also decrease opioid consumption, shorten hospital stays, limit costs, increase postoperative mobilization, and improve maternal-infant bonding. We aimed to determine if the ERAC protocol with multimodal pain control initiated in the year 2021 significantly improved postpartum pain for women who underwent Cesarean section at Henry Ford St. John Hospital in Detroit, MI. We additionally investigated whether the ERAC protocol with multimodal pain control significantly decreased opioid usage for these patients.

We obtained demographic data, medical history, pain scores, and opioid usage measured in morphine milliequivalents (MME) through chart review for 100 women who underwent Cesarean section in 2020 and 100 women who underwent Cesarean section in 2022. Data were analyzed using Student's t-test, chi-squared analysis, the Mann-Whitney U test, Pearson's correlation, and linear regression.

There was no significant difference in pain scores between the two groups. There was, however, a significant difference in MME usage between the groups on postoperative days 1 and 2, which remained significant in the multivariable analyses after controlling for demographic and medical history variables.

At Henry Ford St. John Hospital, the ERAC protocol with multimodal pain control implemented in 2021 resulted in a significant decrease in MME usage on postoperative days 1 and 2, even though there was not a significant decrease in maternal pain scores.