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Oral Concurrent Session 7 - Clinical Obstetrics & Postpartum

Oral Concurrent Sessions

(66) Oral Analgesia in Fixed-Time Interval vs. On-Demand following Vaginal Delivery: A Randomized Controlled Trial

Wednesday, February 14, 2024
3:15 PM - 3:30 PM  
Location: Potomac Ballroom AB, Ballroom Level
Objective: To compare the efficacy of a fixed-time-interval oral analgesia compared to on-demand protocols for the management of post-vaginal delivery pain in the first 24 hours postpartum.

Study Design:

We performed a randomized, prospective, controlled trial, at a single tertiary medical center, between June 2020 to June 2022. Vaginally delivered women were randomly assigned to one of two groups: group 1: oral analgesics of Paracetamol 1 g + Ibuprofen 400 mg every 6 h for the first 24 hours postpartum (per-protocol analgesia group); group 2: same oral analgesics according to maternal request (on-demand group). The primary outcome was pain level during the 1st 24 hours post-delivery, measured on a 10-point visual analog scale (VAS). We estimated that 100 women per group would provide 80% power to identify a 20% difference in the primary outcome.

Results:

From 2020-2022, 200 women were enrolled and included in the analysis: 100 (50%) in study group (per-protocol analgesia) and 100 (50%) in control group (on-demand analgesia). Baseline and delivery characteristics were comparable for all relevant variables, including oxytocin augmentation, epidural anesthesia, episiotomy rate and neonatal weight. VAS score was comparable between study groups (5.31+1.92 vs. 5.29+1.67, p=0.626), even following sub-analysis for nulliparity, episiotomy, and vacuum assisted delivery. However, breastfeeding rates were higher in the per-protocol analgesia group (98% vs. 88%, p=0.006). Additionally, higher satisfaction rates were found among the per-protocol analgesia group (p< 0.05). Women in the per-protocol group received more analgesic treatment with no reported side effects.

Conclusion:

A fixed analgesic protocol for postpartum pain management, compared with an on-demand protocol, following vaginal delivery, is associated with higher breastfeeding rates and better maternal satisfaction though similar VAS scores.