Effect of PCEA vs. PCA post Cesarean Section on Perceived Pain and Breast Feeding Initiation

Purpose:
To identify the most effective modality for pain management in the post cesarean section patient and its effect on breastfeeding behaviors in the first 24 hours post-operatively.

Background/Significance:
In a busy postpartum unit of a community based hospital, Pain Resource nurses observed that women who received patient controlled epidural analgesia (PCEA) demonstrated enhanced pain relief compared to women who received patient controlled analgesia (PCA). Anecdotally, the nursing staff also verbalized that women who received PCEA were able to breastfeed more effectively.

Methods:
A retrospective descriptive comparative correlational study was designed to identify the most effective modality for pain management in the post cesarean section patient and the effect on breastfeeding in the first 24 hours post-operatively. Data was extracted from medical records by an interdisciplinary team for all cesarean deliveries with gestational ages of 34 weeks or greater (N=621).

Results:
Women with PCEA (Mean 2.4, SD 1.3) reported significantly less average pain and required significantly less analgesic adjuvant medication doses in the first 24 hours postpartum compared to women with PCA (Mean 3.2, SD 1.3) management. Women with moderate to severe pain (13.9%) had fewer breastfeeding sessions (5.9) as compared to women with mild pain (28.6%) who breastfed approximately 6.6 times in the first 24 hours post-partum. Time to initial breastfeeding session ranged from 233.7 minutes (PCA) to 251.5 minutes (PCEA).

Conclusions and Implications for Practice:
Findings indicated the best modality for pain relief post cesarean section was PCEA. Recommendations for practice changes included: all appropriate patients to receive PCEA for pain management and strategies were developed to decrease the time of first breastfeeding to within 120 minutes.