PACESS: Post-cesarean Analgesia: Comparing Effectiveness of Staggered v. Simultaneous Therapies
Thomas Jefferson University
Summary
Cesarean delivery is a commonly performed surgical procedure associated with worse postpartum pain when compared to vaginal birth. Uncontrolled postpartum pain is associated with increased neonatal and maternal risks. Multimodal non-opioid pain medications, including acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDs) are the preferred first-line therapies. There is no standard practice, however, on best dosing schedules (ie staggered or different time v. simultaneous or same time). This protocol describes a randomized clinical trial aimed to determine whether staggered dosing of acetaminophen and NSAIDs in superior to simultaneous dosing in controlling post-cesarean pain.
Description
Cesarean delivery is a commonly performed surgical procedure. The rate of cesarean delivery (CD) is increasing in the US; cesarean accounted for 32% of all births in 2022. Parents who deliver via CD experience more pain than those who have a vaginal birth. Uncontrolled postpartum pain can be associated with an increased risk of physical complications including venous thrombosis, atelectasis, pneumonia as well as increased psychological distress. Poor postpartum pain control can also hinder infant-parental bonding and impact breastfeeding initiation or continuation. Multiple strategies for pos…
Eligibility
- Age range
- 16+ years
- Sex
- Female
- Healthy volunteers
- No
Inclusion Criteria: * \>/= 34 weeks gestation * Singleton pregnancy * Delivery via cesarean section under regional anesthesia Exclusion Criteria: * Contraindication to acetaminophen or NSAIDs * Current or history of opioid use or misuse * Intrauterine fetal demise * Major congenital anomaly * Conversion to general anesthesia intra-op or planned general anesthesia * Mid-line vertical skin incision * Receipt of intraoperative local analgesia such as Transversus Abdominis Plan (TAP) block or wound infiltration
Interventions
- DrugAcetaminophen
Acetaminophen 1000 mg q6H
- DrugNSAID (Ketorolac/Ibuprofen)
NSAID (ketorolac 30 mg q6H for first 24 hours post-op followed by ibuprofen 600 mg q6H)
Location
- Thomas Jefferson University HospitalPhiladelphia, Pennsylvania