PAIN MANAGEMENT IN DYSTOCIC DELIVERIES: A PENDING TOPIC
Magaldi M**, González E*, Plaza A**, Martínez MA*, Vendrell M**, Zamora M*

* Midwives of department of Obstetrics and Maternofetal Medicine.
** Department of Anaesthesiology, Resuscitation and Pain Therapy
Hospital Clinic of Barcelona

BACKGROUND AND AIM OF STUDY: Inappropriate management of pain in the immediate postpartum period could affect the wellbeing of the mother and the newborn. Usually, in women with dystocic delivery, conventional analgesia with non-steroidal anti-inflammatory drugs and paracetamol is not enough. 
In our center, we use in these patients a system of non-electronic continuous endovenous infusion of analgesia, which allows prefixing of the hourly infusion rate (elastomeric pumps).
The aim of the study is to evaluate pain registration in post-partum period and to assess the efficacy of analgesia with elastomeric pumps in dystocic deliveries (forceps or spatulas).

MATERIAL AND METHODS: A retrospective analysis in women with dystocic deliveries during a period of 6 months was performed. 
Data collected: type of analgesia (elastomeric pump versus conventional analgesia), pain evaluated with visual analog scale (VAS, 0-10) in the first 48h; and need of analgesic top-ups. To analyse the results, SPSS version 23 was used.

RESULTS: 53 women, mean age 33.77 years, were analysed from 1 June until 31 December 2016. 44 were nulliparous. Forceps was performed in 86.79% of births and spatulas in the rest.
44% of women received analgesia through elastomeric pump with tramadol and dexketoprophen. The rest received conventional analgesia with paracetamol 1gr altern with desketoprophen.
Pain was registered in 22.64% of cases immediately after delivery, and in 72% of cases during the first 48h afterwards, at the conventional hospital ward.
No statistically significant differences were seen between women treated with conventional analgesia vs. those with elastomeric pump (60.71% vs. 54.54%, p>0.05.
82.35% of the women with conventional analgesia asked for extra analgesia compared to 66.66% of those with elastomeric pumps (p = 0.028).

CONCLUSIONS:
- Pain registration is very poor after deliveries. It is crucial for hospitals to improve the culture of avoiding pain in these patients.
- Pain management after dystocic deliveries with elastomeric pumps seems to be useful. There is less need of extra analgesia in women treated with them.
- Further studies are needed to confirm these data.


REFERENCES:

1.- Eisenach JC, Pan PH, Smiley R, Lavand'homme P, Landau R, Houle TT. Severity of acute pain after childbirth, but not type of delivery, predicts persistent pain and postpartum depression. Pain. 2008 Nov 15;140: 87-94. 

06 / Pain management in dystocic deliveries: a pending topic