Pain, stress, analgesia and postpartum depression: Revisiting the controversy with a randomized controlled trial

Association between the use of epidural analgesia during labour and incidence of postpartum depression

“…Kaur et al concluded that percentages of patients with depressive symptoms at 3-days postpartum differed by 2% between mothers received combined spinal and epidural and mothers not received. At 6-weeks postpartum mothers who used analgesia more frequently reported depressive symptoms versus those who did not [27.7% and 16.9%, respectively] [ 27 ]. Moreover, the present study showed that at 6-weeks postpartum, EPDS scores demonstrated that 38.5% of mothers likely had PPD.…”

“…In addition, Tobin et al and Kaur et al reported a lack of a correlation between EA and PPD. Tobin et al screened for PPD at 6–8 days postpartum, while Kaur et al screened for PPD via EPDS at 3-days and 6-weeks postpartum [ 22 , 27 ]. On the other hand, a study conducted in China identified a correlation between EPDS score and PPD both at 3-days and 6-weeks post-delivery [ 25 ].…”

Risk Factors Associated with Somato-Visceral Pain Investigation, in Scheduled Cesarean Section under Epidural Anesthesia with Lidocaine 2% and Adrenaline

“…However, this ideal, is not always got [8]. Hence, pain may wreak havoc on mother and fetus, since it was linked with some mothers' depression [9,11], could impair mother-baby bonding and affect baby's health evolution in the whole puerperium time [9]. We are still wondering how psychological condition would be for those women who request CS without any medical indication supposedly to escape pain and then meet with it during CD.…”

“…Natan Weksler, et al demonstrated how the increased dose of bupivacaine from 7.5-10 mg to 10-12.5 mg decreased the pain rate from 75% to 31.6%. Therefore, 12 ml as total dose of 2% lidocaine with adrenaline can be recommended as a minimum dose, but still needed a heated debate for polarized options approval or further investigations to fix a cutoff of a maximal total LA dose in this area based on each parturient height, in purpose to achieve the ideal of pain-free [9]. Xiangqi di, et al [7], who suggested a determination of optimal dose, by considering the maternal height strongly supported our point of view.…”

“…Not only, according to previous studies via surveys [6], avoiding pain during CS was among the greatest and leading concerns of parturients, but also, pain during CD under neuraxial anesthesia may compromise the comfortability and generate a free self-guilt of anesthesia providers, in view of it has been identified as one of the main causes for a successful medico-legal claim [7]. The surgery requires anesthetic techniques and drugs for pain-free from abdominal visceral traction [8,9], which is among important mothers' anesthetic expectations and outcome preferences [6], then, a criterion for parturients satisfaction [10] which must, This study adhered to the international guidelines for observational Studies according to Strengthening the Reporting of Observational Studies in Epidemiology (STROBE), 2020 statement (see file in Supplementary material/STROBE checklist). Different variables in our data collection encompassed parturients' demographic data (Age, body weight, Maternal height, Body Mass Index, American Society of Anesthesiologists status, Parity, Gravidity, gestation age), surgical data (starting and end time of surgery, fetal extraction time, estimated blood loss) and anesthetic data (amount & time of different doses of LA, vasoactive and opioid agents, muscle relaxion and hypnotic drug, sensory analgesia level , parturient position and site of epidural puncture).…”