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Pressure algometry and mechanical temporal summation do not increase the power of the 3-item questionnaire designed to predict severe postoperative pain in women undergoing cesarean delivery under spinal anesthesia
Abstract Number: O1-4
Abstract Type: Original Research
Postoperative pain after cesarean delivery (CD) remains a great challenge for a specific group of women despite advances in pain management. Approximately 1 in 5 women will experience severe acute postoperative pain (VAS ≥70mm)(1). Pain is a unique experience that is influenced by multiple factors; therefore, the ability to predict women at risk of developing severe pain would allow physicians to tailor specific strategies for this population. A 3-item bedside questionnaire has shown to predict women experiencing evoked pain intensity above 80th percentile after a CD with an area under the receiver operator characteristics (ROC) curve of 0.72 (2). Pain modulation theories propose that individuals exhibiting a facilitated pain response and/or reduced descending pain-modulatory capacities, which can be assessed by psychophysical pain tests (PPT)(3), may experience more pain. We hypothesized that the addition of two PPT- a)pressure algometry (PA); and b)mechanical temporal summation response (TS)- to the existing 3-item questionnaire (3-IQ) would improve the ability to predict severe pain (VAS≥70mm) in women undergoing elective CD under spinal anesthesia
This was a prospective cohort study on women undergoing elective CD under spinal anesthesia. Women were assessed preoperatively using the 3-IQ (2), PA (magnitude) and TS (positive response defined as a difference ≥1cm on a VAS scale 0-10 cm between the 1st and 10th stimulus). All women received standard perioperative care according to our institutional guidelines, including a multimodal analgesia regimen with intrathecal fentanyl and morphine. Postoperative assessments were performed at 24 and 48h after surgery for severity of pain at rest and on movement using a 0-100mm visual analog scale (VAS). Patient satisfaction and opioid consumption were also recorded. A multivariate analysis was performed to predict our primary outcome (VAS on movement at 24h[VASm24])
We studied 195 women. Average age:35.3 years (±4.2); 70% with a previous CD. The mean and 80th percentile of VASm24 were 51.7mm and 75.5mm respectively. The relationship between the primary outcome (VASm24≥70 mm) and the 3-IQ was significant (p<0.01). The correlation between TS and PA with the primary outcome was not statistically significant; similarly, no correlation was observed between TS and PA with morphine consumption. The predictive power for predicting VASm24≥70, assessed by the area under the ROC curve, using the 3-IQ and 3-IQ combined with TS and PA were 0.64 and 0.67 respectively, no significant difference was observed.
We confirmed in our population that the 3-IQ predicts severe pain in women scheduled for CD under spinal anesthesia. However, the addition of two PPT (TS and PA) does not improve its predictive power. Research is warranted in this area to better predict women at risk of severe pain.