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Influence of surgical incision length on chronic postoperative pain after cesarean delivery
Abstract Number: F-40
Abstract Type: Original Research
Reliable predictors for acute and chronic pain after cesarean delivery (CD) are not fully elucidated.
In women undergoing a repeat CD, preoperative scar hyperalgesia was shown to predict acute pain and analgesic use after CD (1).
We hypothesized that surgical incision length is an important factor that can help identify women at risk for acute pain and chronic pain after CD (CPCD).
The primary aim was to evaluate the influence of surgical incision length on CPCD.
Secondary aim was to evaluate the influence of preoperative scar length on pain outcomes among women with a repeat CD.
In this prospective study, 545 women undergoing elective CD with standardized spinal anesthesia and multimodal analgesia were followed up to 12 months postoperatively.
Demographic data, CD incision length, mean acute evoked pain over 48h (verbal pain rating score (VPRS) 0-10), wound hyperalgesia area (WHA; cm2) at 48h, VPRS at 2, 6 and 12 months and self-report questionnaires (SF-MPQ2) were recorded in all women.
In women with a repeat CD, preoperative CD scar length (cm) was measured and women classified in groups based on scar length: Short<14 cm (N=36); Medium=14-17 cm (N=118), Long>17 cm (N=16).
CPCD was defined as VPRS>0 at 12 months.
The overall CPCD rate was 3.7% (20/545 women).
Surgical incision length was correlated with overall pain at 2 months (r=0.121, p=0.005), 6 months (r=0.334, p=0.001) and 12 months (r=0.113, p=0.012).
Women with CPCD had greater acute pain (3.8±2.0 vs 2.9±2.2; p=0.037), longer incision length (16.9±2.0 vs 14.7±1.6; p<0.001), and larger WHA (0.97±1.0 vs 0.39±0.7; p=0.001).
CPCD was present in 11/170 women after repeat CD vs 9/375 after primary CD (CPCD rate 6.5% vs 2.4%; p=0.02).
Preoperative scar length, in women with repeat CD, was associated with pain at 2, 6 and 12 months (Table).
We identified for the first time that previous CD scar and current CD incision lengths are associated with persistent and chronic pain after CD. Findings show the importance of minimizing incision length to reduce CPCD. In addition, we found that women with repeat compared to primary CD are at greater risk for CPCD.
The association between surgical incision length, wound hyperalgesia and pain characteristics including tingling suggest that neuropathic mechanisms may be involved, and further studies are needed to evaluate the contribution of scar length and central sensitization.
1. Eur J Pain 2013;17:111-23