Acute Pain Burden and Opioid Dose Requirements after Cesarean Delivery in Parturients with Preexisting Chronic Back Pain and Migraine

Komatsu, Ryu; Nash, Michael; Ruth, Kenneth C; Harbour, William; Ziga, Taylor M; Mandalia, Shane; Dinges, E.; Singh, Davin; El-Omrani, Hani; Reno, Joseph; Carvalho, Brendan

doi:10.1155/2021/3305579

Anesthesiology Research and Practice

2021

DOI: 10.1155/2021/3305579

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Acute Pain Burden and Opioid Dose Requirements after Cesarean Delivery in Parturients with Preexisting Chronic Back Pain and Migraine

Ryu Komatsu

Michael Nash

Kenneth C Ruth

et al.

Abstract: Introduction. Preexisting chronic pain has been reported to be a consistent risk factor for severe acute postoperative pain. However, each specific chronic pain condition has unique pathophysiology, and it is possible that the effect of each condition on postoperative pain is different. Methods. This is a retrospective cohort study of pregnant women with preexisting chronic pain conditions (i.e., migraine, chronic back pain, and the combination of migraine + chronic back pain), who underwent cesarean delivery.… Show more

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2024

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Predicting severe pain after cesarean section: prospective cohort study

Shindyapina,

Marshalov,

Shifman

et al. 2024

Regional Anesthesia and Acute Pain Management

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BACKGROUND: Severe and unbearable pain after abdominal delivery is recorded in 20% of cases, indicating the limitations of the applied methods of postoperative pain relief and the need for a personalized approach. Tests assessing preoperative pain threshold and anxiety have the greatest sensitivity and specificity as predictors of intense postoperative pain. The informative value of these tests in the Russian obstetric population has not been assessed. OBJECTIVE: This study aimed to determine the optimal method for predicting severe pain after cesarean section (CS). MATERIALS AND METHODS: This prospective cohort study included 212 women who underwent elective CS under spinal anesthesia. The Hospital Anxiety and Depression Scale (HADS) anxiety rating scale, pressure algometry, and cutaneous infiltration anesthesia pain intensity assessment were used as predictors of high-intensity pain. Postoperative pain intensity was assessed using a 10-point Numeric Rating Scale (NRS). The maximum level of pain according to the central pain level at rest (NRSr) and during movement (NRSa) was recorded 24 hour postoperatively. The number of requests for “rescue analgesia” was recorded. The predictive value of the studied methods was determined based on ROC curve analysis. RESULTS: Median (interquartile range) NRSa was 5 [4–5]. Severe pain was recorded in 14% of the patients. The area under the ROC-curve (AUC), reflecting the relationship between severe postoperative pain and pressure-pain threshold, was 0.91±0.03 with 95% confidence interval (CI) of 0.84–0.97 (p 0.001). The relationship between pain intensity during infiltration anesthesia and postoperative pain severity had AUC=0.88 ± 0.04 with 95% CI of 0.81–0.96 (p 0.001). The HADS anxiety score demonstrated the lowest predictive ability (AUC=0.69±0.06; 95% CI, 0.81–0.96; p 0.001). When all three techniques were used together, the AUC was 0.924±0.024 with 95% CI 0.88–0.97 (p=0.001). CONCLUSION: Preoperative pressure-pain threshold and pain severity during infiltration anesthesia are reliable predictors of severe pain after CS. Assessment of preoperative anxiety using HADS has low sensitivity and specificity. However, its use in conjunction with methods for assessing the pain threshold increases the predictive value of the combined model compared with the results of using the methods separately.

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Predicting severe pain after cesarean section: prospective cohort study

Shindyapina,

Marshalov,

Shifman

et al. 2024

Regional Anesthesia and Acute Pain Management

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Pain after cesarean section: do we have reliable predictors? Scoping review

Shindyapina,

Marshalov,

Shifman

et al. 2024

Regional Anesthesia and Acute Pain Management

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BACKGROUND: Every year, the number of publications devoted to the study of various tools for predicting the intensity of pain after cesarean section is growing, which necessitated the generalization and systematization of these data. OBJECTIVE: Our aim was to identify factors contributing to high-intensity pain after cesarean section (CS). MATERIALS AND METHODS: a scoping review based on the PRISMA for Scoping Reviews (PRISMA-ScR) guidelines was conducted using PubMed, Cochrane Database of Systematic Reviews, and Google Scholar. The search was performed using the following keywords: “predictors” OR “prediction” OR “forecasting” AND “cesarean section” AND “pain”) in Russian and English, last search date November 30, 2022. The inclusion criteria for the review were formulated using the PICOD method: (P) population: postpartum women; (I) intervention: CS surgery; (C) comparison: surgical approach, anesthesia method, psychological status, pain threshold, genetic characteristics; (O) outcomes: pain intensity scores, analgesic requirements; (D) study design: prospective/retrospective cohort studies. Exclusion criteria were as follows: lack of sufficient data or outcome of interest; duplicate publication; chronic pain; publications devoted to pain relief during childbirth or pain after other surgical interventions; lack of full-text version; reviews and meta-analyses. The quality of selected non-randomized cohort studies was assessed using the Newcastle-Ottawa Scale (NOS). RESULTS: 30 cohort studies were selected, involving 11,063 patients. Most studies were assigned an NOS score of 6 to 8, which was considered good quality. Two groups of factors were identified as predictors of the intensity of postoperative pain: factors associated with the characteristics of the patient (physical status, psychological status, individual pain threshold and pain tolerance, genetic characteristics) and factors associated with the characteristics of the operation and anesthesia. CONCLUSION: the scoping review allowed us to identify reliable factors predicting high-intensity pain after CS, which should be taken into account when planning anesthesiological care for patients.

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Acute Pain Burden and Opioid Dose Requirements after Cesarean Delivery in Parturients with Preexisting Chronic Back Pain and Migraine

Cited by 2 publications

References 27 publications

Predicting severe pain after cesarean section: prospective cohort study

Predicting severe pain after cesarean section: prospective cohort study

Pain after cesarean section: do we have reliable predictors? Scoping review

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