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Racial Differences in Patient-Controlled Analgesia

      Background: Researchers have consistently demonstrated that non-White patients receive less analgesic medication than Whites, and that tolerance to pain differs among racial groups. Self-administration of analgesia has been infrequently investigated, yet it removes the factor of provider bias, which may contribute to racial disparities in pain management. Inadequate pain management post-Cesarean may delay healing and may compromise maternal-infant interactions.
      Purpose: (1) To determine if there were differences in the frequency of utilization and the dosages of analgesia self-administered through patient-controlled analgesia (PCA) for the first 24 hours following Cesarean birth by African American, Hispanic, and White women; and (2) to determine whether there were differences in the types of analgesic medications prescribed post- PCA for women in the three groups.
      Methodology: Following IRB approval, a stratified random sample of 114 medical records (43 African-American, 35 White, and 36 Hispanic) of women meeting study inclusion criteria (C-Section patients treated with morphine via PCA for up to 24 hours post delivery) were reviewed. Data collected included demographic information, type of anesthesia used, amount of morphine/hr administered, number of PCA attempts made/hr, number of hours PCA used, and pre and post operative complications.
      Findings: There were no significant differences between the groups in the number of attempts/hr while using the PCA (p=26) or the dose of morphine received per hour (p=97). These differences persisted when controlling for age, gravidity, and complications. There also were no differences between the groups in the types of medication ordered (narcotic vs non-narcotic) following discontinuation of the PCA (p=51).
      Summary Concluding Statement: This study found no difference in the amount of analgesia received, the attempts made to receive analgesic medications via PCA, or analgesia prescription post-PCA among C-Section patients of three racial groups. The study indicates that, post-Cesarean, African-Americans, Whites, and Hispanics desire similar amounts of analgesia.