A PROSPECTIVE SURVEY OF APPROPRIATENESS OF PAIN PHARMACOTHERAPY MANAGEMENT IN POST-CESAREAN SECTION PATIENTS IN CIPTO MANGUNKUSUMO HOSPITAL
Objective: In this study, we sought to assess the pattern of analgesic usage, adequacy of pain management, side effects, and analgesic drug interactions
in the post-emergency cesarean surgery setting.
Methods: This was a prospective observational study of 80 patients who underwent emergency cesarean surgery at the Obstetrics and Gynecology
Department of the Rumah Sakit Umum Pusat Nasional Cipto Mangunkusumo (RSUPN-CM) between July 2015 and January 2016. Adequacy of pain
management during the first 3 post-operative days was assessed using Pain Management Index. Relation between pain intensity during activities and
rest with patient characteristic was assessed using Chi-squared test and Fischer’s exact test.
Results: Nineteen patients (8.7%) were prescribed two types of nonsteroid anti-inflammatory drugs concomitantly, and 41.8% received inappropriate
analgesics at a lower frequency. Most patients experienced pain with numerical rating scale score >3 in the first 24 h post-surgery: 59 patients
(73.75%) experienced pain during activities and 7 patients (8.75%) during rest.
Conclusion: Post-emergency cesarean surgery pain management at RSUPN-CM was not optimal. Most patients did not receive adequate pain
management in the first 24 h post-surgery.
Wells BG, editor. Pharmacotherapy a Pathophysiologic Approach.
8th ed. United States: McGraw-Hill; 2011. p. 989.
2. Woldehaimanot TE, Eshetie TC, Kerie MW. Postoperative pain
management among surgical treated patients in an Ethiopian hospital.
PLoS One 2014;9:1-9.
3. Tagaloa LA, Butwick AJ, Carvalho B. A survey of perioperative and
postoperative anesthetic practices for cesarean delivery. Anesthesiol
Res Pract 2009;2009:1-7.
4. Tennant I, Augier R, Sykes AC, Boothe DF, Aitken NM, Jones K, et al.
The Post-Operative Pain Experience and an Assessment of Analgesic
Administration in Elective Surgical Patients at a Teaching Hospital in
Kingston, Jamaica. Priory Lodge Education Limited; 2012. Available
from: http://www.priory.com/anaesthesia/post_operative_pain.htm. [Last
cited on 2018 Sep 02].
5. Gul S, Ayub M. Prevalence of prescribing pattern of more than one
NSAID in Pakistan. J Sci Innov Res 2014;3:148-54.
6. UL Hospitals. Mid-Western Regional Hospitals Complex St. Camillus
and St. Ita’s Hospitals. Analgesic Policy; 2009. p. 5. Available from:
staff/resources/pppgs/analgesicpdf. [Last cited on 2018 Sep 02].
7. Wilmana PF, Gan S. Analgesic-antipyretic analgesics for nonsteroidal
anti-inflammation and other join disorders [In Indonesia] Analgesikantipiretik
analgesik anti-inflamasi nonsteroid dan obat gangguan sendi
lainnya. In: Gunawan S, Setaibudy R, editors. Farmakologi dan Terapi.
5th ed. Jakarta: Gaya Baru; 2009. p. 230-41.
8. Cliard F, Sgro C, Bardou M, Hillon P, Dumas M, Kreftjais C, et al.
Association between concomitant use of several systemic NSAIDs and
an excess risk of adverse drug reaction. A case/non-case study from the
French pharmacovigilance system database. Eur J Clin Pharmacol 2004;
9. Wells N, Pasero C, McCaffery M. Improving the quality of care through
pain assessment and management. In: Patient Safety and Quality: An
Evidence-Based Handbook for Nurses. Vol. 1. Rockville, Md: AHRQ;
2008. p. 469-97.
10. Buvanendran A, Lubenow TR, Kroin JS. Postoperative pain and its
management. In: McMahon SB, Koltzenburg M, Tracey I, Turk DC,
editors. Wall and Melzack Textbook of Pain. 6th ed. Philadelphia, PA:
Elsevier; 2013. p. 633.
11. Cepeda MS. Overview of pain management. In: Approches to Pain
Management an Essential Guide for Clinical Leader. Oakbrook, IL:
Joint Commission Resources; 2003. p. 1-20.
12. Neugebauer EA. Acute pain management. Gen Surg 2009;2009:63-72.
13. Phillips DM. JCAHO pain management standards are unveiled. Joint
commission on accreditation of healthcare organizations. JAMA 2000;
14. Palmer CM, D’angelo R, Paech MJ. Post-Cesarean Analgesia. Oxford:
Oxford University Press; 2011. p. 156-81.
15. Ismail S, Shahzad K, Shafiq F. Postoperative pain management of
cesarean section patient. J Anaesthesiol Clin Pharmacol 2012;28:36-40.
16. Pickering E, Holdcraft A. Pain relief after cesarean section. In:
Kinsella M, editor. Raising the Standard: A Compendium of Audit
Recipes. 2nd ed. London: Royal College of Anaesthetists; 2006.
17. Shen Q, Sherwood GD, McNeill JA, Li Z. Postoperative pain
management outcome in Chinese patients. West J Nurs Res 2008;
18. Horn JR, Hasten PD. Coadministration of NSAIDs and antihypertensive
agents. Pharmacy Times 2006;72:54.
19. Houston MC. Nonsteroidal anti-inflammatory drugs and
antihypertensives. Am J Med 1991;90:42S-7.
20. Webster J. Interactions of NSAIDs with diuretics AND betablockers
mechanisms and clinical implications. Drugs 1985;30:32-41.
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