Nurse Practitioner led Pain Management the day after Caesarean Section: A Randomised Controlled Trial

For the analgesic component of the intervention, participants were prescribed scheduled IR oxycodone doses at 8:00 (10mg), 14:00 (5mg) and 20:00 hours (5mg), commencing the day after CS. Prior to the first dose, the NP allowed participants to discuss their caesarean experience, beliefs about pain and their expectations for pain management. The intervention included discussing concerns regarding analgesics as well as fears about pain when getting up to look after their baby. Any misconceptions were discussed and the proposed pain management plan was explained to each participant. This focused on how IR oxycodone could lessen pain interference on sitting up, mobilising and caring for a newborn. The NP explained that it would take one hour for a dose of IR oxycodone to reach peak analgesic effect, thereby reducing pain when increased pain was anticipated. The NP also explained that additional IR oxycodone or IR tramadol were available on request and that the IR doses only had an analgesic effect for a few hours. Maternal right to refuse any scheduled dose of oxycodone was reinforced in order to transfer decision-making power to participants. Reviews at 11:00 and 14:00 evaluated how participants perceived their progress in terms of pain intensity and function. If analgesia was inadequate, options for pain management were discussed, including commencing 10mg of CR oxycodone at 20:00 hours in place of the scheduled 5mg IR oxycodone dose. Both groups received equal doses of regular oxycodone on the first postoperative day but the groups differed in the formulation used. The control group received controlled-release (CR) oxycodone as the regular dose, whereas the intervention group received regular Immediate-release (IR) oxycodone. Both groups received equal opportunity for changes to their pain management plan.