A study of acute pain after cesarean section - incidence and associated factors, at the university teaching hospital, Lusaka, Zambia.
Background: Some 4,200 caesarean sections were done at the University Teaching Hospital (UTH), Lusaka between September 2015 to September 2016. A 2007 study cited pain was as one of the complications. However, the incidence and possible associated factors to pain after a caesarean section was not evaluated further in that study. The incidence of pain after caesarean section is reported high elsewhere. Caesarean section is an essential life-saving and common surgical procedure. Pain as one of its complication should be well understood to avoid the suffering of patients. There is no data locally on the incidence of acute pain after caesarean section and its associated factors. This study set out to determine the factors associated with acute pain after caesarean section at UTH, Lusaka, Zambia. Methodology: The study was set out to determine the incidence and associated factors of acute pain after elective caesarean section at UTH, Lusaka, Zambia. It was a prospective, cross-section, observational study involving two hundred and forty-six parturients that had a caesarean section at UTH, Lusaka, Zambia. The study lasted for five months and all women who were undergoing elective caesarean section and gave consent were included. All emergency caesarean sections, patient who was taken to the intensive care unit, high dependence unit, who had altered mental state and those who did not give consent were excluded. Consecutive sampling was used to select participants. Information was obtained at 24-hours post-caesarean on socio-demographic, pregnancy and pain management and pain assessed using the Wong-Baker Score. Data were entered into an excel spreadsheet and then analysed using SPSS version 22.0. Chi-square was used to determine the association of independent factors to the dependent factor (Wong-Baker Score). Multiple logistic regression analysis was used to control for confounders and determine factors associated with acute pain 24-hours after caesarean section. Results: The age range of the 246 participants was from 16 years to 45 years. Eighty-four participants had no pain (34.1%), 71 (28.9%) had mild pain, 63 (25.6%) had moderate pain and 28 (11.3%) had severe pain. On bivariate analysis, administration of pethidine, paracetamol and diclofenac was associated with low pain scores. The grade of the surgeon, age of the participant, previous surgery, previous caesarean section, history of dysmenorrhea, joint pains, headache, backache, bilateral tubal ligation, level of education, the expectation of pain, anxiety or depression were not associated with acute pain. On multivariate analysis, only a history of the previous caesarean was associated with moderate-severe pain: OR 0.47 (95%CI 0.26-0.84, p=0.0101). Conclusion: The incidence of acute pain at UTH, Lusaka, was significant - over one-third (36.9%) complained of moderate to severe pain at 24-hours based on the Wong-Baker Score. A history of previous caesarean section was the only factor that was associated with moderate to severe pain. However, the odds ratio <1 implied those with a previous caesarean had less association with moderate to severe pain. More research is needed to optimize pain relief after caesarean section. Keywords: Caesarean section, Pain scores, Wong-Baker Score
Cesarean section--Complications., Cesarean section.
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