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Risk factors for postcesarean pain immediately postoperative period and 1 month postpartum.
Abstract Number: T-55
Abstract Type: Original Research
Neuraxial morphine is commonly used for postcesarean analgesia, but we sometimes encounter patients who require frequent supplemental analgesic. Also, we do not know who may suffer persistent pain after cesarean section. The purpose of this study is to identify risk factors that are associated with increased pain immediately postoperatively and at 1 month postpartum, so that we can better tailor the analgesic method for each patient.
After IRB approval, all patients undergoing elective or emergency cesarean section between August and November, 2013 were recruited to this prospective observational study. Patients were asked to fill anxiety inventory (STAI) at the time of preanesthetic visit. Possible risk factors for postcesrean pain were recorded including psychiatric and surgical history, uterine diseases, current medication, number of previous cesarean sections. Intraoperatively, patients’ anxiety, response to local infiltration before spinal anesthesia, type of uterine incision, and supplemental analgesic were recorded. Postoperative assessments include time until first ambulation, analgesic use, pruritus, PONV. Visual Analogue Scale scores (VAS) were recorded at 12, 24, 48, 72 hours postoperatively. At 1 month postpartum, VAS and SFMPQ (short form McGill Pain Questionnaire) were recorded at routine postpartum visit.
All 91 patients who were recruited consented to this study.
Immediate postoperative pain were not associated with any of the above factors. The incidence of persistent pain (VAS≥31mm) at 1 month postpartum was 8.8% (8/91). The factors associated with pain at 1 month include surgical history (P=0.05), as well as preoperative state anxiety (lower in persistent pain group). Other factors were not significantly different between those with and without persistent pain at 1 month postpartum.
The incidence of persistent pain after cesarean section in our patient population was almost the same with previous studies. Persistent pain was associated with a surgical history other than CS. However, we were unable to confirm other factors such as type of skin incision and association between immediate postoperative pain and persistent pain. Interestingly, women with higher preoperative state anxiety complained less pain at 1 month postpartum. Future study should include factors such as breastfeeding and postpartum depression while extending follow up period.