Maternal Satisfaction with Opioid-Free Versus Opioid-Based Post Caesarean Section Analgesia among Preeclamptics on Magnesium Sulphate: A Randomised Clinical Trial

Background: While multimodal non-opioid analgesia may help reduce opioid-related side effects, opioid use can still lead to dose-dependent tolerance, dependence, and addiction in some patients, impacting maternal satisfaction. This limitation has sparked interest in opioid-free multimodal analgesia, which combines non-opioid and adjuvant analgesics on a scheduled basis, reserving opioids for rescue analgesia only. Magnesium sulfate, an adjuvant analgesic, is a suitable component of opioid-free analgesia, particularly for preeclamptic women on magnesium sulfate undergoing caesarean section, as it may contribute to improved maternal satisfaction and outcomes. Aim: To determine and compare maternal satisfaction in opioid-free analgesia treated preeclamptic women and opioid-based analgesia treated preeclamptic women undergoing caesarean section. Methods: Ethical approval was obtained from the research ethics committee of Federal Medical Centre, Yenagoa. The study was a superiority randomized clinical trial. One hundred preeclamptic women undergoing caesarean section who gave consent and met the eligibility criteria was enrolled into the study. Sampling method was convenience sampling. Randomization was carried out by using WINPEPI. There were two groups with 50 participants in group A (experimental arm) and 50 participants in group B (control arm). Experimental arm received postoperative intravenous paracetamol, intramuscular placebo and rectal diclofenac for 24 hours. Control arm received postoperative intramuscular pentazocine, intravenous paracetamol and rectal diclofenac for 24 hours. Rescue analgesia (intramuscular pethidine) was administered to women in this study outside the established analgesic regimen for both arms of the study if needed. A Likert scale was used to assess maternal satisfaction 24 hours post-surgery. Statistical significance was pValue <0.05. Results: Patients in the treatment arm B reported less severe pain (0% vs. 38%), greater satisfaction with pain relief (68% vs. 28%), and a higher likelihood of recommending the treatment (68% vs. 44%). Fewer patients in the treatment arm B rated their satisfaction as poor or very poor (12% vs. 34%), and more rated it as excellent (34% vs. 0%). However, dissatisfaction with pain relief methods was prevalent in both groups (92% vs. 98%). Statistical significance was observed in pain experience (0% vs. 38%), satisfaction (28% vs. 68%), and perceived effectiveness (0% vs. 34%). Conclusion: While opioid-based multimodal analgesia provided significantly better pain relief and higher maternal satisfaction, opioid-free multimodal analgesia remained a viable and acceptable alternative for postoperative pain management in preeclamptic women receiving magnesium sulphate after caesarean section.