ESRA Academy. Sinha N. Sep 9, 2016; 138558; 0428 Topic: Acute Postoperative Pain - Postoperative & Perioperative Analgesia
Dr. Navneet Sinha
Dr. Navneet Sinha

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Background and Aims:


NSAIDs have been shown to reduce opioid requirements when combined with paracetamol after operative delivery. Though concerns exist regarding their use in patients with known renal impairment or one with risk factors for its development. The normal physiological changes of pregnancy may further complicate Acute Kidney Injury (AKI) diagnosis postpartum.




 We present the case of a 22 year old primi-gravida with twin pregnancy and pre-eclampsia who underwent category 3 Caesarian section at 35 weeks for not able to adequately manage the blood pressure. Intra-Operative blood loss of 2000ml and post operative prescription NSAID,s for pain relief  led her to develop acute Kidney Injury (AKI) post partum. Although decreasing urine output and raising creatinine pointed towards diagnosis but not in time to prevent it. 



The normal physiological changes of pregnancy are associated with a 40-50% increase in glomerular filtration rate, with a resultant decrease in serum creatinine and urea. A creatinine that may be considered normal within the non-obstetric population may in fact indicate acute kidney injury (AKI) in a pregnant patient. NSAIDs act by inhibiting cyclo-oxygenase, thereby inhibiting prostaglandin synthesis, which leads to constriction of the afferent renal arteriole and consequently reduces renal perfusion pressure.



Our case highlights several deficiencies in adequate post partum management of this lady. Multidisciplinary Team Meeting was held and key missed points were recognized and acted upon. One such point was to have guidelines in place for NSAID’s prescription post partum. 

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