Postpartum pain relief: a randomized comparison of self-administered medication and standard administration.

OBJECTIVE: To compare pain relief in postpartum women receiving analgesia administered by nurses with the relief achieved by use of self-administered medication (SAM). METHOD: This randomized trial included women in spontaneous or induced labour or admitted for elective Caesarean section (CS). Women were stratified according to the mode of delivery. In the standard group, nurses administered the medications. In the SAM group, women kept the medications at the bedside and recorded each dose. The women were asked to record their pain level with a validated scale before and one hour after the administration of analgesia. A global pain score was calculated using the mean of these scores, and the satisfaction of patients and nurses with the process was recorded. RESULTS: We recruited 345 women for the study. Eleven women (3.15 %) were lost to follow-up. We analyzed data from 197 women in the vaginal delivery arm and 133 women in the CS arm. There was no difference between the global pain scores before and one hour after the administration of analgesia in each group, independent of the mode of delivery. Women who used SAM and had a vaginal delivery were significantly more likely to have used no medication (P = 0.02) or to have used acetaminophen (P = 0.008), and fewer of these women took naproxen (P = 0.05). No significant difference was seen in women who had CS. Narcotic use was similar in each group. Women who used SAM were more likely to indicate that they would choose this method again and recommend it to others. The level of satisfaction with SAM expressed by nurses did not change after the study. CONCLUSION: Postpartum pain relief was similar for women who had standard administration of medication by nurses and those who had SAM. More women using SAM used either no medication or acetaminophen only, and more women using SAM were highly satisfied with their method of pain relief. Use of self-administered medication should be considered for every postpartum unit.

Granulosa cell tumour: a recurrence 40 years after initial diagnosis.

BACKGROUND: Granulosa cell tumours are rare ovarian malignancies accounting for 2% to 5% of ovarian tumours. They are characterized by late recurrences, with the latest recurrence reported 37 years after first diagnosis. CASE: A 73-year-old woman who had surgery for a granulosa cell tumour in her early 30s and who presented with a recurrence 40 years later. CONCLUSION: Patients and their physicians should be made aware that there is a potential for a granulosa cell tumour to recur many years in the future.