• Pamela Snell and Carolyn Hicks.
• Birmingham Women's Hospital, Metchley Park Road, Edgbaston, Birmingham, UK.
• Midwifery. 2006 Sep 1;22(3):249-61.

ObjectiveTo compare the effects of three types of analgesic administration after elective caesarean section on a number of clinical outcome measures. Supplementary aims of the study were to determine the acceptability of, and satisfaction with, the different regimens.DesignA quasi-experimental different subject design was used to compare three types of analgesic administration on pain, post-operative nausea and vomiting, analgesic consumption, length of hospital stay and overall satisfaction with pain management.SettingA specialist women's hospital in a large UK city, with around 1500 caesarean sections per annum.Participants95 women who had undergone elective caesarean section.InterventionsThe women were allocated to one of the three pain management groups: group 1 (oral morphine, Co-dydramol and diclofenac [all self-administered]); group 2 (oral morphine, Co-dydramol and diclofenac [all midwife-administered]); and Group 3 (intra-muscular morphine, oral Co-dydramol and diclofenac [all midwife-administered]). The safety of self-medication was measured by adherence to a safety protocol.MeasurementsData collection was undertaken over the first 3 days after surgery and included visual analogue scale (0-100mm) pain scores, analgesic consumption, incidence of post-operative nausea and vomiting, and length of hospital stay. In addition, questionnaires were given to midwives and patients to assess the acceptability of self-medication and patient satisfaction. Data collection took place between June 2002 and June 2003.FindingsThe results indicated that the outcomes of all three interventions were comparable in terms of pain scores, incidence of post-operative nausea and vomiting, and overall levels of satisfaction, although intra-muscular morphine was disliked to a degree that deterred some women from requesting it. Consumption of oral morphine was significantly greater than consumption of intramuscular injections of morphine, whereas Co-dydramol use was lower in the self-medicating group; the self-medicating women also went home, on average, a day earlier than women in the other two groups.

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