Breastfeeding success and its relation to maternal pain, behaviour, mental health, and social support.

OBJECTIVE: We aimed to understand the maternal experience of breastfeeding onset and how psychological, social and clinical variables as pain during breastfeeding, may interfere with it. METHODS: A cross-sectional study investigated 395 post-delivery women able to breastfeed from 48 hours to 6 days for unpleasant breastfeeding, maternal stress during pregnancy and postnatal mental state. Social Readjustment Rating Scale evaluated prenatal maternal stress. Perceived Maternal Parenting Self-Efficacy Scale, Pain Catastrophizing Scale - Parent version, and Edinburgh Postnatal Depression Scale evaluated maternal mental state. RESULTS: Unpleasant breastfeeding experience showed to be positively related to the longer number of days the pain lasts; late onset of breastfeeding; less search for information about pregnancy and baby care (p < .01); lower catastrophizing behaviour towards infant´s stress and C-section delivery (p < .04). Pain levels were positively correlated to longer periods of pain, later onset of antenatal consultations and depression (p < .05). Binary logistic regression pointed to the effects of lower self-efficacy and pain in breastfeeding, higher depression levels, gestational stress, labour adversities and success in breastfeeding. CONCLUSIONS: The relationship among maternal perceived self-efficacy, anxious and depressive thoughts, catastrophizing behaviours, and unpleasant breastfeeding need to be evaluated to elucidate the best health professional intervention.

Reduced Pain and Opioid Use in the Early Postoperative Period in Patients Undergoing a Frontotemporal Craniotomy under Regional vs General Anesthesia.

INTRODUCTION: This study compares the postsurgical course of frontotemporal craniotomies conducted "awake" under regional anesthesia (RA) versus "asleep" under general anesthesia (GA) to investigate postoperative recovery, pain, opioid use, and anesthesia-related side effects. METHODS: We retrospectively reviewed craniotomies for supratentorial, intra-axial tumors with frontotemporal exposure. Chronic opioid use and emergent cases were excluded. Primary outcomes included pain scores on a 0-10 numerical rating scale, opioid use as oral morphine milligram equivalence, first time to opioid use, nausea, and sedation on the Richmond Agitation and Sedation Scale (RASS). Secondary outcomes included postoperative seizures, Karnofsky Performance Scale (KPS) status, and hospital length of stay (LOS). RESULTS: A total of 91 patients met inclusion criteria: 56 underwent a craniotomy under RA versus 35 under GA. Demographics and operative characteristics were similar between cohorts. A significant reduction in both postoperative pain and opioid use was observed among RA versus GA (first postoperative pain score 2 vs. 5, P < 0.01; postoperative day [POD] 0 median pain score 2.5 vs. 4, P < 0.01; POD 0 mean opioid in mg 14.49 vs. 24.43, P < 0.01). The time until patients requested opioids for pain after surgery was prolonged for RA versus GA [mean 7.23 vs. 3.42 hours, P < 0.01). Somnolence (RASS < 0) on POD 0 was significantly reduced among RA versus GA, with 23% versus 43%. Both cohorts had equivocal postsurgical outcomes such as seizures, KPS, and hospital LOS. CONCLUSIONS: Frontotemporal craniotomy under RA during awake craniotomies provides better pain control, a reduction in opioid use, and less somnolence in the early postoperative period.