Impact of Postoperative Pain on Early Initiation of Breastfeeding and Ambulation After Cesarean Section: A Randomized Trial

Abstract

<b><i>Aim:</i></b> To compare the effect of different analgesic regimens on the time to initiate breastfeeding (BF) and ambulation after cesarean section (CS). <b><i>Methods:</i></b> This prospective, double-blinded, placebo-controlled randomized study included 300 women (20-40 years of age) of the American Society of Anesthesiologists status 1 or 2 with singleton term pregnancies scheduled for CS under spinal anesthesia. Women were allocated to three groups of 100 each by computer-generated randomization. As an adjunct to 1,000 mg intravenous acetaminophen, Group 1 received 100 mg rectal diclofenac, Group 2 received 100 mg rectal tramadol, and Group 3 received rectal glycerin suppository. The time to initiate BF and ambulation was compared between different analgesic regimens and corelated with pain score. <b><i>Results:</i></b> BF (both with and without support) was initiated significantly earlier in Groups 1 and 2 as compared with control Group 3 (<i>p</i> < 0.001). A significantly shorter time was taken to initiate BF without support in Group 1 as compared with Group 2 (<i>p</i> = 0.028). The time to start ambulation (both with and without assistance) was significantly lower in Groups 1 and 2 as compared with Group 3 and in Group 1 versus Group 2 (<i>p</i> < 0.001). A significant positive correlation was found between the time to initiate BF with support and ambulation without assistance and postoperative pain score at 0, 1, and 6 hours. <b><i>Conclusion:</i></b> Effective post-CS analgesia affects early initiation of BF and ambulation in the immediate postnatal period. The inclusion of rectal diclofenac suppository in post-CS analgesic regimens is a promising approach to postoperative delivery care.