Cesarean delivery is a commonly performed surgical procedure associated with worse postpartum pain when compared to vaginal birth. Uncontrolled postpartum pain is associated with increased neonatal and maternal risks. Multimodal non-opioid pain medications, including acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDs) are the preferred first-line therapies. There is no standard practice, however, on best dosing schedules (ie staggered or different time v. simultaneous or same time). This protocol describes a randomized clinical trial aimed to determine whether staggered dosing of acetaminophen and NSAIDs in superior to simultaneous dosing in controlling post-cesarean pain.
>/= 34 weeks gestation
Singleton pregnancy
Delivery via cesarean section under regional anesthesia
Contraindication to acetaminophen or NSAIDs
Current or history of opioid use or misuse
Intrauterine fetal demise
Major congenital anomaly
Parallel
Acetaminophen
DrugAcetaminophen 1000 mg q6H
NSAID (Ketorolac/Ibuprofen)
DrugNSAID (ketorolac 30 mg q6H for first 24 hours post-op followed by ibuprofen 600 mg q6H)
Postpartum pain control
Visual analog pain score (VAS) with movement. Scale ranges from 0-10 with 0 indicating no pain and 10 indicating worst possible pain
Opioid consumption
Opioid consumption (in total morphine milligram equivalents (MME))
Postpartum pain at 6 hours
Visual analog pain score with rest. Scale ranges from 0-10 with 0 indicating no pain and 10 indicating worst possible pain
Postpartum pain at 12 hours
Visual analog pain score with rest and movement. Scale ranges from 0-10 with 0 indicating no pain and 10 indicating worst possible pain
Postpartum pain at 24 hours
Visual analog pain score with rest and movement. Scale ranges from 0-10 with 0 indicating no pain and 10 indicating worst possible pain
Postpartum pain at 48 hours
Visual analog pain score with rest. Scale ranges from 0-10 with 0 indicating no pain and 10 indicating worst possible pain
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