http://www.revistadechimie.ro REV.CHIM.(Bucharest)♦69♦No.12♦2018 Pharmacologic Therapy in Postpartum Pelvic Pain Management ALEXANDRA MATEI 1# , CRINGU IONESCU 2 , MIHAI DIMITRIU 2 *, CORINA ILINCA 3 , DIANA GHEORGHIU 1# , MIHAI BANACU 2 , DAN CALIN 2 , LIANA PLES 2 , ADRIAN NEACSU 2 , GEORGE ROSU 1 1 St Pantelimon Clinical Emergency Hospital, Department Obstetrics Gynecology, 340 Pantelimon Road, 021661, Bucharest, Romania 2 Carol Davila University of Medecine and Pharmacy, Department Obstetrics Gynecology and Neonatology, 37 Dionisie Lupu Str, 020021, Bucharest, Romania. 3 University of Bucharest, Faculty of Sociology and Social Work and Statistical Office, 4-12 Regina Elisabeta Blvd, 030018, Bucharest, Romania 4 Dunarea de Jos University of Galati, 47 Domneasca Str, 800008, Galati, Romania Women’s perception on childbirth experience is frequently related to pain struggle, regardless the type of birth. We aimed to present our Department’s experience on pharmacologically treating postpartum related pain. We developed a 6 months retrospective, descriptive study which included a number of 305 patients. Two sample patients were formed depending on the type of birth. In the sample of vaginal delivery a correlation between episiotomy and Paracetamol consumption was found (Pearson correlation of 0.238). In the sample of cesarean section births, for Acupan, Ketoprofen and Algifen the correlations with epidural anesthesia are negative and statistically significant at the 99.9% confidence level. Keywords: analgesia, postpartum pain, episiotomy, epidural anesthesia *email:drmihaidimitriu@yahoo.com # Both authors contributed equally to this article Women’s perception on childbirth experience is frequently related to pain struggle, regardless the type of birth. Pain intensity, pain-related disability, pain duration and pain aûect are the aspects that deûne pain and its effects [1]. Although the first three can be easily assessed using various instruments, pain affect defined as the degree of emotional arousal or changes in action readiness caused by the sensory experience of pain [2] is often more difficult to objectify. Pain can be perceived differently especially under the specific neurohormonal changes characterizing immediate postnatal period. The direct effects on the mother’s wellbeing and her ability to care for her infant are strong aspects that influence initiation of specific therapy. Postpartum depression affects 1 in 7 mothers [3]. The negative impact on the patient’s psychological health sometimes resulting in maternal suicide has brought this pathology into specialist’s attention once more. Even if it is still underdiagnosed in many healthcare systems and neglected by the medical research field, evidence suggests that an association exists among acute postpartum pain, chronic pain and postpartum depression [4,5]. Whether it is related to the pelvic trauma of vaginal birth or to the surgical scar after caesarean section, pain under all its forms remains the major most common symptom to treat after delivery. American College of Obstetricians and Gynaecologists states that nonpharmacologic and pharmacologic therapies are important components of postpartum pain management [6]. It is known that pain is multifactorial, therefore multimodal analgesia is the best approach [7]. It uses drugs that have different mechanisms of action which potentiates the analgesic effect [6]. Depending on the intensity and the subjective complaints regarding pain experience, patients are usually given analgesics following a stepwise approach. Step one includes nonopioid analgesics (eg, acetaminophen or nonsteroidal anti-inflammatory drugs - NSAID), step two adds milder opioids (eg, codeine, hydrocodone, oxycodone, tramadol, oral morphine), and step three incorporates stronger opioids (eg, parenteral morphine, hydromorphone, fentanyl) [6]. We aimed to present our Department’s experience on pharmacologically treating postpartum related pain by analysing all medical records on patients who delivered in our clinic between December 2017 and May 2018. We focused especially on the use of the following commercial pharmacological products: Paracetamol (acetaminophen), Acupan (nefopam hydrochloride), Algifen (metamizole, pitofenone hydrochloride and fenpiverinium bromide) and Ketoprofen (propionic acid derivate). Experimental part We developed a 6 months retrospective, descriptive study which included a number of 305 patients who delivered in our Department. Inclusion criteria were based on the informed consent of the patient to take part in this study along with admission for delivery in St. Pantelimon Emergency Hospital during December 2017 to May 2018. Patients who gave written refusal to follow any prescribed therapy on the medical chart were excluded from this study. Women diagnosed with postnatal complications such as infections, haemorrhage or haematomas were not considered. All data was gathered from each patient’s electronic medical record stored in Info World application as well as from their admission papers. We considered being relevant the entire therapeutical plan of patients during their hospitalization after delivery, with focus on the administration of the following pharmacological commercial products: number of Paracetamol vials along with Ketoprofen, Algifen and Acupan ampoules. Other drugs destined to treat comorbidities were not taken into account. Also, we did not evaluate the opioid drug use because in our department Mialgin-the only compound used from this class - is administered scarcely. This analysis is based on descriptive statistics (number of cases, percentages, mean, standard deviation, minimum and maximum) and correlational analysis (providing Pearson correlations and the statistical significance level). We used IBM SPSS Statistics, version 22. 3622