A Prospective Cohort Study Evaluating the Ability of Anticipated Pain, Perceived Analgesic Needs, and Psychological Traits to Predict Pain and Analgesic Usage following Cesarean Delivery (original) (raw)
Related papers
Predictors of post-caesarean section pain and analgesic consumption
Journal of Anaesthesiology Clinical Pharmacology, 2011
Background: Background: Ideally, the intensity of postoperative pain should be predicted so as to customize analgesia. The objective of this study was to investigate whether preoperative electrical and pressure pain assessment can predict post-caesarean section pain and analgesic requirement. Materials and Methods: Materials and Methods: A total of 65 subjects scheduled for elective caesarean section, who gave written informed consent, were studied. Preoperatively, PainMatcher ® was used to evaluate electrical pain threshold, while manual PainTest™ FPN 100 Algometer and digital PainTest™ FPX 25 Algometer determined pressure pain threshold and tolerance. Postoperatively, numerical rating scales were used to assess pain at regular time intervals. Patients received intramuscular pethidine (100 mg, 6 hourly), rectal diclofenac (100 mg, 12 hourly), and oral paracetamol (1 g, p.r.n.) for pain relief. Statistical analysis was conducted using PASW Statistics 18 software.
Pre-operative pain sensitivity: A prediction of post-operative outcome in the obstetric population
Journal of Anaesthesiology Clinical Pharmacology, 2013
Context: Experimental assessments can determine pain threshold and tolerance, which mirror sensitivity to pain. This, in turn, influences the post-operative experience. Aims: The study intended to evaluate whether the pre-operative pressure and electrical pain tests can predict pain and opioid requirement following cesarean delivery. Settings and Design: Research was conducted on females scheduled for cesarean section at a tertiary care hospital of the state. Twenty women were enrolled, after obtaining written informed consent. Materials and Methods: Pain assessment was performed on the eve of cesarean sections using three devices: PainMatcher ® determined electrical pain threshold while the algometers PainTest ™ FPN100 (manual) and PainTest ™ FPX 25 (digital) evaluated pressure pain threshold and tolerance. Post-operative pain relief included intravenous morphine administered by patient-controlled analgesia, diclofenac (100 mg, every 12 h, rectally, enforced) and paracetamol (1000 mg, every 4-6 h, orally, on patient request). Pain scores were reported on numerical rating scales at specified time intervals. Statistical Analysis Used: Correlational and regression statistics were computed using IBM SPSS Statistics 21 software (IBM Corporation, USA). Results: A significant correlation was observed between morphine requirement and: (1) electrical pain threshold (r =-0.45, P = 0.025), (2) pressure pain threshold (r =-0.41 P = 0.036) and (3) pressure pain tolerance (r =-0.44, P = 0.026) measured by the digital algometer. The parsimonious regression model for morphine requirement consisted of electrical pain threshold (r 2 = 0.20, P = 0.049). The dose of morphine consumed within 48 h of surgery decreases by 0.9 mg for every unit increment in electrical pain threshold. Conclusions: The predictive power of pain sensitivity assessments, particularly electrical pain threshold, may portend post-cesarean outcomes, including opioid requirements.
Predicting Acute Pain after Cesarean Delivery Using Three Simple Questions
Anesthesiology, 2013
Background: Interindividual variability in postoperative pain presents a clinical challenge. Preoperative quantitative sensory testing is useful but time consuming in predicting postoperative pain intensity. The current study was conducted to develop and validate a predictive model of acute postcesarean pain using a simple three-item preoperative questionnaire. Methods: A total of 200 women scheduled for elective cesarean delivery under subarachnoid anesthesia were enrolled (192 subjects analyzed). Patients were asked to rate the intensity of loudness of audio tones, their level of anxiety and anticipated pain, and analgesic need from surgery. Postoperatively, patients reported the intensity of evoked pain. Regression analysis was performed to generate a predictive model for pain from these measures. A validation cohort of 151 women was enrolled to test the reliability of the model (131 subjects analyzed). Results: Responses from each of the three preoperative questions correlated m...
Multifactorial Preoperative Predictors for Postcesarean Section Pain and Analgesic Requirement
…, 2006
Background: The study aimed to determine predictive factors for postcesarean pain and analgesia using an assessment of pain threshold and suprathreshold thermal stimuli as well as degree of somatization and anxiety. Methods: Thirty-four healthy parturients scheduled for cesarean delivery under subarachnoid anesthesia were enrolled. Preoperative thermal pain threshold, intensity, and unpleasantness to heat stimuli applied to arm and lower back, State Trait Anxiety Inventory, and patient expectation for postoperative pain and need for analgesia were assessed. After surgery, overall, resting, and movement pain and analgesic consumption were recorded. Prediction of pain and analgesic use outcomes was made by principal component factor analysis, followed by stepwise linear regression. Results: Resting pain was predicted by two factors, thermal pain and unpleasantness and patient expectation (r 2 ؍ 0.26, P < 0.01), evoked pain by thermal pain threshold in the back (r 2 ؍ 0.20, P < 0.009), composite pain by thermal pain and unpleasantness and preoperative blood pressure (r 2 ؍ 0.28, P < 0.008), intraoperative analgesic need by preexisting pain (r 2 ؍ 0.22, P < 0.006), recovery room analgesia by thermal pain threshold and State Trait Anxiety Inventory (r 2 ؍ 0.27, P < 0.01), and total analgesic need by State Trait Anxiety Inventory (r 2 ؍ 0.22, P < 0.01). These models predicted the upper twentieth percentile of composite pain scores and analgesic requirement with sensitivity of 0.71 to 0.80 and specificity of 0.76 to 0.80. Conclusions: The authors' results suggest a meaningful combination of preoperative patient responses from physical and psychological tests yields a valid multifactorial predictive model for postoperative pain and analgesic requirement with significant improvements over individual predictive variables.
Pain Intensity among Women with Post-Caesarean Section: A Descriptive Study
KnE Life Sciences, 2019
Background: The frequency of Caesarean section increased from 5% to 15% across the world. According to statistics, it is highest in the U.S. or around 24%, and then in Canada about 20%, in Denmark about 13%, 10% in England, and it is lowest in Japan 7%. Post-cesarean section women experience pain due to operative trauma. Individual variability of postoperative pain is influenced by multiple factors, including sensitivity to pain, psychological factors, age, and genetics. Cesarean delivery patients have even more compelling reasons to achieve optimal postoperative pain relief than other surgical patients, but they also present unique challenges. Post cesarean delivery patients are at a higher risk for thromboembolic events, which may also be precipitated by immobility from inadequate pain control or excessive sedation from opioids. Objectives: This research aimed to describe pain intensity among women with post-cesarean Section. Methods: This research conducted at an obstetric ward in...
International journal of obstetric anesthesia, 2010
Studies examining the effects of various analgesics and anesthetics on postoperative pain following cesarean delivery conventionally use the scheduled cesarean population. This study compares postoperative analgesic requirements and recovery profiles in women undergoing scheduled cesarean compared to unplanned cesarean delivery following labor. We postulated that unplanned cesarean deliveries may increase postoperative analgesic requirements. We conducted a retrospective chart review of 200 cesarean deliveries at Lucile Packard Children's Hospital, California. We examined the records of 100 patients who underwent scheduled cesarean delivery under spinal anesthesia (hyperbaric bupivacaine 12 mg with intrathecal fentanyl 10 microg and morphine 200 microg) and 100 patients that following a trail of labor required unplanned cesarean under epidural anesthesia (10-25 mL 2% lidocaine top-up with epidural morphine 4 mg after clamping of the umbilical cord). We recorded pain scores, anal...
Journal of Clinical Medicine
Cesarean section (CS) is the most widely performed and one of the most painful surgeries. This study investigated postoperative pain after CS using patient-related outcomes (PROs) to identify risk factors for severe pain. The secondary outcome was to evaluate the influence of surgery indication (primary CS (PCS) vs. urgent CS (UCS)). This multi-center, prospective cohort study included data submitted to the pain registry “quality improvement in postoperative pain treatment” (QUIPS) between 2010 and 2020. In total, 11,932 patients were evaluated. Median of maximal pain was 7.0 (numeric rating scale (NRS) 0 to 10); 53.9% suffered from severe pain (NRS ≥ 7), this being related to impairment of mood, ambulation, deep breathing and sleep, as well as more vertigo, nausea and tiredness (p < 0.001). Distraction, relaxation, mobilization, having conversations, patient-controlled analgesia (PCA) and pain monitoring were shown to be protective for severe pain (p < 0.001). Maximal pain in...
Patient-controlled versus nurse-controlled post-operative analgesia after caesarean section
Advanced Biomedical Research, 2012
Background: The aim of this study was to compare the differences in the quality of analgesia by patientcontrolled analgesia (PCA) and nurse-controlled analgesia (NCA) for post-caesarean section analgesia. Materials and Methods: 350 women who undertake elective cesarean section were assigned to the three groups. Group I (n=200), IV-PCA morphine; group II (n=100), IV-PCA methadone; group III (n=50) NCA morphine. Data collected during the 24 h observation period included visual analog scale (VAS) pain and patient satisfaction scores, the incidence of nausea and vomiting, severe sedation and pruritis. Results: VAS pain scores for each time at which it was evaluated were higher for NCA group than other groups. Also patient satisfaction was significantly increased in the IV-PCA Group as compared with group III. The prevalence of pruritis was higher for NCA group than other groups. Conclusion: In post caesarean section, PCA morphine or methadone improves 24-h VAS compared with NCA.
Spinal versus general anesthesia in cesarean sections: the effects on postoperative pain perception
Archives of Gynecology and Obstetrics, 2012
Objective To compare postoperative pain perception and analgesia requirements in patients undergoing cesarean section (CS) using general versus spinal anesthesia. Study design A prospective, observational study of patients undergoing elective CS during 2009 under either general or spinal anesthesia. Postoperative pain intensity and analgesia requirements were evaluated for up to 48 h after surgery. Results A total of 153 women were enrolled; 77 received general and 76 received regional anesthesia. Postoperative meperidine requirements in the Wrst 24 h were signiWcantly higher in the general anesthesia group. Pain scores were mostly comparable between the groups. Nevertheless, lower pain scores were graded after 8 h in the general versus the spinal anesthesia and this reversed at 48 h. Conclusion Spinal anesthesia is comparable to general anesthesia in terms of post-operative pain control. In choosing the type of anesthesia in CS, other factors such as the urgency and potential maternal and fetal hazards should be taken into account.
Journal of Clinical Nursing, 2010
Aim. The aim was to evaluate a new anaesthetic routine and to study the effect of spinal opioids for caesarean section on postoperative pain, expectations of pain, satisfaction with pain treatment, breastfeeding, infant care and length of hospital stay. Background. Inadequate postoperative pain relief is a problem among hospitalised patients. Women undergoing caesarean section have been shown to experience high levels of pain during the first days after operation. Women are expected to breastfeed and care for their newborn while recovering from major abdominal surgery and sufficient pain relief are of importance. Design. Comparative patient survey. Methods. Data were collected through a questionnaire distributed to two independent samples of women undergoing elective and emergency caesarean section before and after the introduction of an additive of opioids in obstetric spinal anaesthesia. Chisquare tests were performed, and risk ratios were used for bivariate analysis. Logistic regression modelling was used for multivariate analysis. Results. The group of women undergoing caesarean section with opioids added to the spinal anaesthesia reported significantly lower levels of experienced pain. High pain levels irrespective of mode of caesarean section affected breastfeeding and infant care. Length of hospital stay for caesarean women was shortened and the consumption of analgesics was reduced. Conclusions. Women receiving an additive of opioids in spinal anaesthesia experienced lower levels of pain. Low pain levels facilitate breastfeeding and infant care and are of relevance for financial considerations. Relevance to clinical practice. The results of this study indicate that spinal opioids for women undergoing caesarean section have a positive effect on the postoperative pain experience. Women undergoing caesarean section and have high pain levels are in special need of attention and care because of a higher risk of a decreased ability to breastfeed and to take care of their newborn.