OBJECTIVE: To assess patient controlled epidural analgesia (PCEA) versus patient controlled analgesia (PCA) for postcesarean analgesia and to determine the impact of analgesic modality on breastfeeding in the first 24 hours postpartum. DESIGN: A retrospective, descriptive, comparative, correlational design. SETTING: A metropolitan, community, teaching hospital in the northeast United States. PARTICIPANTS: Medical records for all women with cesarean births in 2007 of at least 34 weeks gestational age (N = 621). METHODS: Following Institutional Review Board approval, electronic medical records and clinical charts were reviewed by the study team. Data were analyzed with PASW version 18.0. RESULTS: Women with PCEA reported significantly less average pain (p = .000) and required significantly less analgesic adjuvant medication doses (p = .038) than women with PCA. Statistically significant negative correlations were found for average total pain score with number of breastfeeding sessions (p = .023). Controlling for confounders, women with PCEA had 2.2 times the odds of mild pain compared to PCA (p = .03). Women with mild pain (adjusted odds ratio [aOR] = 2.4, p = .03), term neonate (aOR = 3.2, p = .006), breastfeeding within 2 hours (aOR = 3.2, p = .000), and no supplemental feedings (aOR = 6.9, p = .002) had significantly greater odds of breastfeeding 6+ times in the first 24 hours. CONCLUSION: Patient-controlled epidural anesthesia confers greater pain control postcesarean than PCA. Women with greater pain are less likely to breastfeed six or more times within the first 24 hours. This could potentially affect duration of breastfeeding. Intraprofessional measures to improve pain management are warranted.
OBJECTIVE: To assess patient controlled epidural analgesia (PCEA) versus patient controlled analgesia (PCA) for postcesarean analgesia and to determine the impact of analgesic modality on breastfeeding in the first 24 hours postpartum. DESIGN: A retrospective, descriptive, comparative, correlational design. SETTING: A metropolitan, community, teaching hospital in the northeast United States. PARTICIPANTS: Medical records for all women with cesarean births in 2007 of at least 34 weeks gestational age (N = 621). METHODS: Following Institutional Review Board approval, electronic medical records and clinical charts were reviewed by the study team. Data were analyzed with PASW version 18.0. RESULTS:Women with PCEA reported significantly less average pain (p = .000) and required significantly less analgesic adjuvant medication doses (p = .038) than women with PCA. Statistically significant negative correlations were found for average total pain score with number of breastfeeding sessions (p = .023). Controlling for confounders, women with PCEA had 2.2 times the odds of mild pain compared to PCA (p = .03). Women with mild pain (adjusted odds ratio [aOR] = 2.4, p = .03), term neonate (aOR = 3.2, p = .006), breastfeeding within 2 hours (aOR = 3.2, p = .000), and no supplemental feedings (aOR = 6.9, p = .002) had significantly greater odds of breastfeeding 6+ times in the first 24 hours. CONCLUSION:Patient-controlled epidural anesthesia confers greater pain control postcesarean than PCA. Women with greater pain are less likely to breastfeed six or more times within the first 24 hours. This could potentially affect duration of breastfeeding. Intraprofessional measures to improve pain management are warranted.
Authors: Ravindu P Gunatilake; Geeta K Swamy; Leo R Brancazio; Michael P Smrtka; Jennifer L Thompson; Jennifer B Gilner; Beverly A Gray; Robert Phillips Heine Journal: AJP Rep Date: 2017-07-14