Maternal Satisfaction and Postoperative Pain Severity in Mothers Who undergo Caesarean Section under General and Spinal Anesthesia in Gandhi Memorial Hospital, Addis Ababa, 2014

Background: The main purpose of health care system should be adequate and appropriate treatment and health care management of the patients. Body of evidence revealed that maternal satisfaction and postoperative pain control were better in mothers who gave birth under spinal anesthesia than general anesthesia. However evidences are lacking locally, hence, this study was aimed to compare maternal satisfaction and postoperative pain severity in mothers who undergo caesarean section under general anesthesia and spinal anesthesia. Methods: After approval from institutional review Board (IRB), we studied 120 consecutive ASAI-II mothers who gave birth with cesarean section under spinal and General Anesthesia in Gandhi Memorial Hospital from august, 2013-July, 2014. Prospective effectiveness study design was employed. Patients were randomly allocated in two equal groups 60 patients each by lottery method after informed consent. Mothers with spinal Anesthesia group was preloaded with 1-1.5 litres of crystalloids before spinal Anesthesia and Spinal Anesthesia was given with 2-2.5ml of 0.5% bupivacaine in sitting position with strict aseptic technique. General Anesthesia was induced with rapid sequence induction with 3.5mg/kg of thiopental and 1-2mg/kg succinylcholine. General Anesthesia was maintained with 1-1.5v% halothane, 0.1mg/kg of vecronium and 1.5-2mg/kg of Pethdine. In the postoperative period, pain severity was measured at 2, 6 and 24hrs with Visual Analog Score (VAS) along with first analgesic request and satisfaction was assessed with Likert scale. Results: The total response rate of the study was 120 (100 %). The study revealed that types of anesthesia were independent predictor of maternal postoperative pain severity. Postoperative pain severity is greater than two times in Mothers who underwent caesarean section under general anesthesia than spinal anesthesia [AOR=2.4, 95% CI=1.03, 5.6]. Maternal satisfaction had no significant association with types of anesthesia by independent chi square test (P>0.078). The median time of first analgesic request in mothers underwent caesarean section under spinal anesthesia and general anesthesia was 93±4.2 and 80±3.9 minutes respectively. The mean intraoperative Systolic Blood pressure was lower in Anesthesia group as compared to general Anesthesia group unlike estimated blood loss which was higher in General Anesthesia group. Conclusion: The median time of first analgesic request was better in spinal analgesia compared to general anesthesia. However, Spinal anesthesia was associated with high incidence of hypotension. Appropriate perioperative patient care by anesthetist and provision of drugs for treatment of pain and hypotension were recommended.