EPISTEMOLOGY
6. Reflexive The research had personal implications for me within several roles
A total of one hundred and twenty eight (128) patients who met the eligibility criteria were randomized to have oral sips commenced within 6hours of Caesarean section or after the onset of bowel sound, with sixty four (64) patients in each group.
Profile of the Patient
The mean age and the parity were similar in both groups as shown in Table 1. The mean age of the study was 30.97+/- 3.36 years and that of the control group was 30.97+/- 4.65 years. The p value was 0.934 meaning that there is no statistical significant
difference in the mean age of the two groups.
The parity was also similar in both groups, 1.16 +/- 1.07 versus 1.23 +/- 1.12 in the study and control group respectively. The p value is 0.688 implying that there is no statistical significant difference in the parity of the two groups. (See Table I)
Duration of the Surgery
The duration of the surgery was similar in both group (44.30 +/- 18.10 minutes in the study group and 44.53 +/- 11.57 minutes in the control group) as shown in Table II.
The p value was 0.931 revealing there is no statistical significant difference in the duration of surgery of the two groups.
Type of Anaesthesia
The type of anaesthesia employed were spinal and general anaesthesia in both group. Table III shows that there is no statistical significant difference in the type of anaesthesia used in both group. (Chi-square 0.288)
xlvi Type of Caesarean Section
For the purpose of this study, Caesarean section was classified into electives and emergency. Table IV shows that there was no statistical significant difference in the type of Caesarean section employed in both group. (Chi-square 0.288)
Onset of Bowel Activity
There was a statistically significant difference in the onset of bowel activity.
Bowel sound was noticed earlier in the study group,( 7.31+/- 0.96 hrs) compared with the control group (16.15 +/- 7.83 hrs), p value < 0.0001. This is highlighted in Table V below.
The time full bowel sound was noticed in hours was also earlier in the study group and it was statistically significant. Study group (8.25+/-1.04 hrs) versus control group (20.13+/-9.47 hrs), p value < 0.0001.
The time of passage of first flatus or belching indicating presence of bowel activity was also recorded and analyzed. It was found out to be earlier in the study group compared with the control group. (14.28 +/-5.55 hrs versus 26.78+/-9.40 hrs, p value <
0.0001) (See Table V)
Bowel Sound at Six and Eight hours Post Surgery
As shown in Table VI below, the intensity of bowel sound at six and eight hours were compared. It was found out that the intensity of the bowel sound were higher in the study group compared to the control group. Among the study group, 92.3% had full bowel motion at eight hours compared to 7.7% of the control group. The Pearson Chi-square is <0.0001.
xlvii Incidence of Gastrointestinal Morbidity
The incidence of gastro intestinal morbidity as judged by the incidence of nausea/vomiting, abdominal distention and constipation were minimal and they were similar in both group. They were not statistically different. There were two cases of nausea /vomiting in each group, one cases of abdominal distention in each group, and two cases of constipation in the study group and three cases in the control group.
(Nausea/Vomiting, Chi-Square 1.0, Abdominal distention, Chi-square 1.0, and Constipation , Chi-square 0.648, Exact Fisher test 1.00).
Time to Ambulation in the Post-operative Period
As shown in Table VII below, the time to ambulate in the post operative period was earlier in the study group compared with the control group. (12.56 +/- 4.04 versus 22.47 +/- 5.73 respectively, p value <0.0001)
Degree of Post-operative Pain
This was determined by using the 4 Point Verbal Pain Score and the number on opiod analgesics used by the patient.
From Table VIII, there was a statistical significant difference in the number of opiod analgesic used. The study group required less number of opiod analgesics when compared with the control group. (3.30 +/- 0.84 versus 4.30 +/- 1.12, p value <0.0001)
Table IX shows the assessment of post operative pain using the 4 Point Verbal Pain Score. It shows that the study group experienced pain of less severity compared to the control group, (Pearson Chi-square < 0.0001). Of the study group, only 8.3% had
xlviii
moderate pain against 91.7% of the control group. None of the two group reported incidence of severe post operative pain.
Patient Satisfaction
Majority of patient in the study group (37 out of 39, that is 94.5%) who has had Caesarean section in the past and was managed with the delayed feeding practice felt that the early feeding method is better than the delayed feeding method. Two of them reported that it the same, however none of them reported it to be worse than the delayed method.
In contrast, 8 out of the 34 eligible patients in the control group were more dissatisfied while 24 out of 34 shown the same satisfaction when compared with previous Caesarean section. (See Table X)
The entire study group was asked to state their satisfaction of the treatment given, 71.8% of them rated it to be good, and 25.0% rated it to be excellent. None of them rate the method as bad. (See Table XI)
Patient Preferences
Majority (38 out of 39, that is 97.4%) of the patient in the study group who has had previous Caesarean section in the past and was managed by delayed feeding practice preferred this method.
xlix TABLES
TABLE 1: PROFILE OF THE PATIENTS
Profile of Patients
Study Group (Early
Feeding) N=64 Mean +/- S.D
Control group (Delay
Feeding) N=64
Mean+/-S.D
P value Interpretation
Age(Years) 30.97+/-3.86 30.91+/-4.65 0.934
Not Significant
Parity(Number) 1.16+/-1.07 1.23+/-1.12 0.688
Not Significant
l TABLE 1I: DURATION OF SURGERY
Duration of Surgery
Study Group (Early
Feeding) N=64 Mean +/- S.D
Control group (Delay
Feeding) N=64
Mean+/-S.D
P value Interpretation
Duration of
Surgery(mins) 44.30+/-18.10 44.53+/-11.57 0.931
Not Significant
li
TABLE III: TYPES OF ANAESTHESIA USED.
Type of Anaesthesia
Study Group (Early Feeding) N=64 Mean +/- S.D
Control group (Delay Feeding) N=64
Mean+/-S.D
Pearson Chi-square
Interpretation
Spinal 110 General 18
57 (51.8%) 7 (38.9%)
53 (48.2%) 11 (61.1%)
0.309 Not Significant
lii TABLE IV: TYPE OF CAESAREAN SECTION.
Type of Caesarean Section
Study Group (Early Feeding) N=64 Mean +/- S.D
Control group (Delay Feeding) N=64
Mean+/-S.D
Pearson Chi-square
Interpretation
Elective 68 Emergency 60
31 (45.6%) 33 (55.0%)
37 (54.4%) 27 (45.0%)
0.288 Not Significant
liii TABLE V: ONSET OF BOWEL ACTIVITY
Onset of Bowel Activity
Study Group (Early
Feeding) N=64 Mean +/- S.D
Control group (Delay
Feeding) N=64
Mean+/-S.D
P value Interpretation
Time of first bowel
sound ( hrs) 7.31+/-0.96 16.15+/-7.83 < 0.0001
Statistically Significant Time of full bowel
sound (hrs) 8.25+/-1.04 20.13+/-9.47 < 0.0001
Statistically Significant Time first noticed
flatus / belch (hrs) 14.28+/-5.55 26.78+/-9.40 < 0.0001
Statistically Significant
liv
TABLE VI: BOWEL SOUND AT SIX AND EIGHT HOUR POST SURGERY.
Bowel Sound at 6 and 8 hours Post
Surgery
Study Group (Early Feeding) N=64 Mean +/- S.D
Control group (Delay Feeding) N=64
Mean+/-S.D
Pearson Chi-square
Interpretation
Bowel Sound at 6 hours
Absent 103 Scanty 23 Full 2
41 (39.8%) 21 (91.3%) 2 (100%)
62 (60.2%) 2 (8.7%) 0 (0.05)
< 0.0001 Statistically Significant
Bowel Sound at 8 hours
Absent 43 Scanty 20 Full 65
0 (0.0%0 4 (20.0%) 60 (92.3.0%)
43(100%) 16 (80.0%) 5(7.7%)
< 0.0001
Statistically Significant
lv
TABLE VII: TIME TO AMBULATION POST OPERATION
Ambulation Time
Study Group (Early
Feeding) N=64 Mean +/- S.D
Control group (Delay
Feeding) N=64
Mean+/-S.D
P value Interpretation
Time of full
ambulation (hrs) 15.56+/- 4.04 22.47+/- 5.73 < 0.0001
Statistically Significant
lvi
TABLE VIII: DEGREE OF POST OPERATIVE PAIN USING NUMBER OF OPIOD ANALGESICS
Number of opiods Analgesic
Study Group (Early
Feeding) N=64 Mean +/- S.D
Control group (Delay
Feeding) N=64
Mean+/-S.D
P value Interpretation
Number of Opiod Analgesics given ( Number)
3.30+/- 0.84 4.30+/- 1.12 < 0.0001
Statistically Significant
lvii
TABLE IX: DEGREE OF POST OPERATIVE PAI N USING 4 POINT VERBAL PAIN SCORE
4 Point Verbal Pain Scoring Scale
Study Group (Early Feeding) N=64 Mean +/- S.D
Control group (Delay Feeding) N=64
Mean+/-S.D
Pearson Chi-square
Interpretation
No Pain Mild Pain Moderate Pain Severe Pain
- 59 (86.8%) 5 (8.3%)
- - 9 (13.2%) 55 (91.7%) -
< 0.0001
Statistically Significant
lviii TABLE X: PATIENT SATISFACTION
Satisfaction Rating of Patient who had previous Caesarean
section with delayed feeding
compared to present Caesarean
section.
Study Group (Early Feeding) N=64 Mean +/- S.D
Control group (Delay Feeding) N=64
Mean+/-S.D
Pearson Chi-square
Interpretation
Worse 8 Same 26 Better 37 Not applicable 57
0 (0.0%) 2 (7.7%) 37(100%) 25
8 (100.0%)
24 (92.3%) 0 (0.0%)
30
< 0.0001 Statistically Significant
lix
TABLE XI: SATISFACTION RATING AMONG THE STUDY GROUP
Satisfaction Rating among the Study group
Study Group (Early Feeding) N=64
Bad Fair Good Excellent
0
2 (3.2%) 46 (71.8%) 16 (25.0%)
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TABLE XII: PREFERENCES OF EARLY POST OPERATIVE FEEDING AMONG THE STUDY GROUP WHO HAD PREVIOUS CAESREAN SECTION
Preferences
Study Group Who Had Previous Caesarean Section
N=39
Preferred Not Preferred
38 (97.4%) 1 (2.8%)
lxi