Chronic Pain following caesarean section - A trivial pursuit?
Abstract Number: F-3
Abstract Type: Original Research
Management of acute pain after caesarean section (CS) has evolved considerably over the past decade. Despite current advances, it may still be inadequate for a substantial number of women.
Also, its not until recently that chronic pain has been accepted as an important outcome of surgery. Prevalence of chronic pain after CS is around 12% (1) and 2/3rd of women with chronic pelvic pain had a history of CS.(2)
We wanted to compare our pain relief score and maternal satisfaction to the standards set by the Royal College of Anaesthetists(3) and also the incidence and predicting factors for persistent pain.
It is a prospective study of 150 women who had CS, looking at intra and postoperative pain scores on a visual analogue scale (VAS) of 0-10cms and maternal satisfaction ratings. As the second part of the study, we conducted a telephone survey at 6 and 12 months assessing for persistent pain and its effect on the quality of life.
98(65%) women had their CS under Spinal anaesthesia, 32(21%) under Epidural top up, 4(2%) under General anaesthesia. Opiates, predominantly diamorphine(75%) were used in all regional techniques.
96(64%) at rest and 37(24%) on movement had acute pain score of <3. A VAS score of >7 were noted in 13% of women at rest and 33% on movement.
At 6 months, of the 105 respondents, 37(35%) had persistent pain at scar site (21), back (11), pelvis (2) and both scar site and back (3). 18 women suffered infection at the wound site and it attributed to increase in pain by 50%.
25% of patients who had acute postoperative pain developed chronic pain. The quality of life was affected moderately in only 1 patient.
At 12 months, we received 57 replies. Only 25 of the previous 37 patients with pain responded. Scar pain was experienced by 3 patients, back pain by 4. 1 patient attended the chronic pain clinic for pelvic pain. The quality of life was preserved in all women.
There is a large inter-individual variation in analgesia requirements. A literature search revealed that we are not alone in failing to meet the standards. Despite not achieving the target, 99% of women were satisfied with post CS pain relief.
25% of patients who had acute postoperative pain developed chronic pain. Infection played an important role in the development of chronic pain. The choice of anaesthesia did not seem to alter our incidence of acute or chronic pain.
Although the incidence of chronic pain was 35% and 14% at 6 and 12 months respectively, it did not have any effect on the women’s lifestyles and the quality of life was preserved in all women.
1. Nikolajsen L et al. Chronic pain following CS. Acta Anesthesiol Scand 2004; 48: 111-116
2. Almeida et al. CS as a cause of chronic pelvic pain. International Journal of Obstetrics & Gynaecology 2002; 79: 101-104
3. Royal College of Anaesthetists. Raising the Standard; A compendium of audit recipes. 2006; 168-9