Factors associated with patient satisfaction with pain management among postcaeserean section mothers at kawempe national referral hospital

Abstract

The prevalence of caesarean section has been noted to increase world over with current estimates ranging from 55.7% in Brazil, 50.8% in Turkey to 46.9% in Romania hence making CS the most performed surgical procedure in the world. As the number of cesarean sections being performed increases world over, controlling post-operative pain is becoming increasingly important. Many patients are observed at Kawempe National Referral Hospital to be in severe pain and unable to ambulate due to poorly controlled pain and satisfaction with post cesarean section pain management is anticipated to be low. Data regarding satisfaction with post cesarean pain management in Ugandan hospitals is extremely scarce. This study aimed to determine the level and factors associated with satisfaction with post CS pain management at Kawempe National Referral Hospital (KNRH). MethodsThe study was a cross sectional analytical study based at Kawempe National Referral Hospital. Consecutive sampling technique was used to recruit 335 participants who had delivered from KNRH into the study between 15th march and 30th April 2023from post-natal and HDU wards after obtaining written informed consent. An interviewer administered questionnaire adopted from the APS-POQ-R and the pain treatment satisfaction scale was used to collect data by trained research assistants from participants and other information noted from patients’ files. Statistical analysis was carried out using STATA version 14. Continuous variables were summarized using means and standard deviations while categorical data as frequencies and proportions. Bivariate analysis was carried out and variables with p-values < 0.2 were considered for multivariate analysis using Log-binomial regression with statistical significance set at p-value < 0.05. Results: Among 335 women involved in this study had mean age 26.3 years. Of these, 39.4% had a caesarean section done before and among these 43.9% reported having experienced moderate pain from the previous CS. At any time, 77.6% of study participants used multimodal analgesia. Overall, we found that 71.6% of participants were satisfied with their post CS pain management. At multivariate analysis, receiving analgesia within less than 30 minutes after request for it or when it was time for medication were more likely to be satisfied with their pain management (aPR=1.45, 95% CI: 1.01 – 2.09). Also, women who reported to have been allowed to participate in decisions about their pain treatment as much as they wanted to (aPR=1.62, 95% CI: 1.20 – 2.19) and the use of multimodal analgesia at any time (aPR=1.43, 95% CI: 1.01 – 2.05) were significantly associated with being satisfied with post CS pain management. Conclusion: In this study, use of multimodal analgesia, receipt of analgesia within less than 30 minutes upon request or administration time and allowing women to participate in decisions regarding their pain treatment were significantly associated with satisfaction with pain management post CS. These should be reinforced on wards handling such women so as to improve quality of care offered following caesarean section.