Disparities in Post Cesarean Section Pain Management

Alison Wiles, Electra Korn, Cheryl Dinglas, Beth Bentley, Jonathan Rosner, Salma Rahimi


Background: Racial and ethnic disparities exist across all fields of healthcare, especially regarding assessment and treatment of pain. English language proficiency is a less frequently considered and studied aspect contributing to healthcare inequities. We evaluated if the frequency of pain assessment, severe pain scores, and medication administration after cesarean delivery differed by patient race and ethnicity and primary language in women after cesarean delivery at our hospital.

Methods: We performed a retrospective cohort study of all women who underwent cesarean birth resulting in a liveborn neonate at a single institution between January 1, 2018 and June 30, 2018. Pain scores documented and medications administered after delivery were grouped into 0 - 24 and 25 - 48 h postpartum time periods. Number of pain scores recorded, whether any pain score was 7 - 10 out of 10, and type and amounts of analgesic medication including non-steroidal anti-inflammatory drugs (NSAIDs) and oxycodone therapeutic equivalents (OTEs) were evaluated.

Results: The number of pain assessments was lowest in Hispanic and non-English speaking patients. No differences were observed in pain scores ? 7 between groups by race and ethnicity or primary language. NSAID doses were lowest in non-English speaking patients at 0 - 24 (P < 0.05) and 25 - 48 h (P < 0.05) postpartum and in black patients at 25 - 48 h postpartum (P < 0.0009). OTE doses were similar between groups by race and ethnicity and primary language at 0 - 24 h postpartum. OTE doses were lowest in Hispanic and non-English speaking patients and highest in black patients at 25 - 48 h (P < 0.05).

Conclusions: Racial, ethnic, and language-related inequities in postpartum pain assessment and treatment were found in our study. The exact cause of these disparities remains unclear. Further work can be done through standardization of postpartum order sets to eliminate these disparities.

J Clin Gynecol Obstet. 2022;11(2):27-32
doi: https://doi.org/10.14740/jcgo786


Post-operative pain; Racial disparities; Ethnic disparities; Narcotic; NSAID; Pain assessments

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Journal of Clinical Gynecology & Obstetrics, quarterly, ISSN 1927-1271 (print), 1927-128X (online), published by Elmer Press Inc.                     
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