EVALUATION OF POSTOPERATIVE PAIN MANAGEMENT STRATEGIES FOLLOWING CESAREAN SECTION IN DERA ISMAIL KHAN

Abstract

Cesarean section is one of the most commonly performed obstetric surgical procedures worldwide and is an important life-saving intervention when vaginal delivery may endanger the mother or fetus. However, cesarean section is associated with significant postoperative pain due to abdominal incision, tissue trauma, uterine contractions, and inflammatory responses. Poorly controlled postoperative pain can delay maternal recovery, reduce early mobilization, interfere with breastfeeding, disturb maternal–infant bonding, prolong hospital stay, and decrease overall maternal satisfaction. Therefore, effective postoperative pain management is an essential component of quality obstetric and anesthesia care. The present study was conducted to evaluate postoperative pain management strategies following cesarean section in hospitals of Dera Ismail Khan. The main objectives were to identify commonly used analgesics and pain management methods, assess postoperative pain severity, evaluate side effects of analgesics, and determine maternal satisfaction with postoperative pain management. A descriptive cross-sectional observational study design was used. A total of 150 women aged 18–45 years undergoing elective and emergency cesarean sections were included through convenience sampling. Data were collected using a structured questionnaire. Pain severity was assessed by using the Visual Analog Scale (VAS), while maternal satisfaction and side effects were also recorded. Data were analyzed using SPSS, and results were presented in the form of frequencies, percentages, tables, and figures. The findings of the study showed that postoperative pain remained an important clinical issue among women after cesarean section. Most participants experienced mild pain at rest, while pain intensity increased during movement. Mild pain at rest was reported by 82.7% of participants, moderate pain by 12.7%, and severe pain by 4.7%. However, during movement, mild pain decreased to 58.7%, while moderate pain increased to 33.3% and severe pain increased to 8.0%. These findings indicate that movement-related pain was more common than pain at rest and may affect early ambulation, breastfeeding, and maternal self-care. The commonly used analgesics included opioids, non-steroidal anti-inflammatory drugs, and paracetamol. Pethidine and tramadol were commonly used opioid analgesics, while diclofenac sodium and paracetamol were used as co-analgesics. Multimodal analgesia provided better pain control compared with single-drug therapy because it acts through different pain pathways and reduces the need for excessive opioid use. Regarding side effects, 61.3% of participants reported no side effects, while nausea, vomiting, drowsiness, pruritus, and urinary retention were reported in some patients. Maternal satisfaction was generally good, as 48.7% of women were satisfied and 24.0% were highly satisfied with pain management. However, 27.3% were not satisfied, indicating the need for improvement in postoperative pain assessment and analgesic practices. Conclusion:  Hence it is concluded that Postoperative pain after cesarean section is still a major issue, especially during movement. Better pain assessment, timely analgesics, counseling, and standardized pain management protocols are needed to improve maternal recovery and care.