Oral painkillers best after C-section

NEW YORK (Reuters Health) – 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.