Adequacy of pain management and its predictors following cesarean section: a longitudinal data analysis using a generalized estimating equation model

Abstract

Adequate pain management is now an integral part of modern surgical practice. Postoperative pain management minimizes patient suffering and complications. However, the adequacy of pain management following cesarean section and its predictors is not covered yet. This study aims to evaluate the adequacy of pain management among women undergoing cesarean section and its predictors by using longitudinal data to get a deeper look at the problem. A Prospective longitudinal study design was employed to assess the adequacy of postoperative pain management and its predictors following cesarean section from June 3rd to December 27th, 2024. A pre-prepared structured questionnaire was used to collect data from patients’ medical charts and study participants. Data were analyzed by using SPSS version 27. Descriptive statistics were applied to sociodemographic and certain clinical parameters. A logit link function of the generalized estimating equation model (GEE) was used to model the binary outcome variable, which is the adequacy of postoperative pain management relative to different predictors. Frequency and percentage were used to present the findings of baseline data. Odd ratios with 95% CI and p-values of < 0.05 were used to declare the association between the outcome and the independent variables. A total of 423 patients with a response rate of 100% completed the study. The adequacy of pain management was 49.6%, 62.9%, 76.4%, and 90.1% at 6, 12, 24, and 48 h of postoperative time, respectively. Being married, having a shorter duration of surgery, receiving intrathecal pethidine as an additive, receiving multimodal analgesia during the first 6 h after surgery, receiving a bilateral transverse abdominis plane block with diclofenac as a type of multimodal analgesia during the first 6 h of postoperative time, and receiving additional analgesia during 6–48 h of postoperative time were found to be the predictors of adequate postoperative pain management after cesarean section. Pain management following cesarean delivery was found to be suboptimal. Anesthesia providers should consider intrathecal pethidine, bilateral transverse abdominis plane block with diclofenac as a type of multimodal analgesia during the first 6 h, and additional analgesia during 6–48 h of postoperative time to have adequate pain management after cesarean section.