Real‐world effectiveness of pain pharmacotherapy for caesarean section in a low‐ and middle‐income setting: A multicentre cross‐sectional study in Ghana

AIMS: Effective analgesia is needed after caesarean section to enhance maternal health-related quality. Unfortunately, little is known about the realities on the ground in low-and middle-income countries. This study investigated the prevalent perioperative pharmacotherapeutic practices in Ghanaian healthcare settings for women undergoing elective caesarean section and their association with acute postoperative pain. METHOD: A multicentre cross-sectional study was conducted among 515 women who underwent elective caesarean section at four teaching hospitals in Ghana. Demographic and clinical data were collected using structured questionnaires and medical record reviews. Acute postoperative pain was assessed using the Numerical Pain Rating Scale (NRS) within the first 72 h after surgery. Data were analysed using R (Version 4.6.1). Statistical significance was defined as p < 0.05. RESULTS: Moderate to severe acute postoperative pain was reported by 60.0% (95% CI: 55.7%-64.1%) of participants despite widespread use of opioid-based analgesia. Multimodal analgesia was associated with significantly lower acute postoperative pain (OR = 0.34; 95% CI: 0.22-0.48; p < 0.001). The use of midazolam was associated with a 62% reduction in the odds of acute post-surgery pain (OR = 0.38; 95% Bootstrap CI: 0.20-0.63; p < 0.001). CONCLUSION: Multimodal analgesia was associated with superior postoperative pain control compared with opioid-based therapy alone; however, the persistently high prevalence of moderate to severe pain indicates substantial gaps in the implementation of contemporary pain management strategies during and following caesarean deliveries in Ghana.