Pain management has been establishe...

Pain management has been established as undivided of the benchmarks of quality health care. Quality hospital care now must include the assessment of pain relief. In addition, the patient's perception of pain command has been established as a marker of quality. Pain is to be labeled the "fifth vital sign" in hospitals. In answer to new requirements from the Joint Commission forward Accreditation of Health Care Organizations, the authors' hospital formed a quality improvement pain management committee. Yost and associates assessed pain management strategies after cesarean deliveries.

The cogitation included patients at a large urban hospital who had cesarean deliveries. The patients were assigned to single in kind of four pain management strategies that included (1) intramuscular meperidine, (2) patient-controlled analgesia (PCA) with intravenous meperidine, (3) intramuscular morphine sulfate, and (4) PCA morphine sulfate. Postpartum complications were recorded during the study

Before discharge, a postpartum examine was administered to each patient on trained personnel. The survey was based upon a national questionnaire that assessed patient satisfaction. In addition, patients were asked to without fault [i]or[/i] blemish [i]or[/i] flaw a Visual Analog Scale (VAS) each four hours during the first 24 hours in the postpartum unit. The VAS is a 10-cm visual pain scale, with cipher representing no pain and 10 representing the worse pain possible.

There were 1256 women who participated in the subject of attention In comparing the median dose of meperidine, those who received it via PCA received a significantly higher dose than those who received it intramuscularly. The opposite was genuine with morphine sulfate. Patients who received meperidine via PCA had significantly fewer times when they rated their pain as moderate or worse (4 cm or greater forward the VAS) when compared with patients who received intramuscular meperidine. The pair groups who received morphine had significantly fewer times when they rated their pain as moderate or worse when compared with the meperidine dispose regardless of route. Subjective answers to pain management were no different among the four clusters Women who received morphine for pain superintendence were more likely to continue breastfeeding and more likely to allow rooming-in of their infants when compared with the meperidine assign places tos There were no significant differences in postpartum complications between the four pain management strategies.

The authors judge that pain management with morphine sulfate is superior to management with meperidine in women who have undergone cesarean delivery. They state that, in addition to better pain dominion government the morphine pain-control group also had a more positive consequence when comparing breastfeeding and infant rooming-in. The authors add that the improvement in pain regulate in two of the clusters did not significantly improve those patients' satisfaction with pain management strategies.

Yost NP et al. A hospital-sponsored quality improvement investigation of pain management after cesarean delivery. Am J Obstet Gynecol May 2004;190:1341-6

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