Patient and procedural risk factors for increased postoperative pain after cesarean delivery under neuraxial anesthesia: a retrospective study

Saab, Remie; Chen, Z.; Li, Y.J.; Habib, Ashraf S.

doi:10.1016/j.ijoa.2020.07.006

Cited by 12 publications

(5 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…On the other hand, several studies have demonstrated that Black patients have a lower threshold to painful stimuli and report more postoperative pain than White patients ( 16 , 17 , 19 ). Some have reported on this disparity even when regional anesthesia has been used ( 20 ). This higher burden of pain has been attributed to physiological, social, cultural and provider-level reasons ( 21 ).…”

Section: Discussionmentioning

confidence: 99%

Race, ethnicity, and the use of regional anesthesia in cancer patients undergoing open abdominal surgery: A single-center retrospective cohort study

et al. 2022

View full text Add to dashboard Cite

BackgroundWhere applicable, regional anesthesia has been shown to be superior to opioid or non-opioid analgesic modalities alone. However, some studies have shown ethnic-based disparities in the use of regional anesthesia in patients undergoing surgical procedures. In this study of patients who had undergone major oncologic surgery, our main objective was to compare the use of regional anesthesia between patients of different ethnicities.MethodsA retrospective review of adults who had undergone major open abdominal surgical procedures between 2016 and 2021 was performed. Logistic regression models were used to assess the association between baseline patient characteristics and the use of regional anesthesia.ResultsA total of 4,791 patients were included in the analysis. The median age was 60.5 years [interquartile range, 49, 69], the majority were female (65%), and of American Society of Anesthesiologists Physical Status Class (ASA) 3 (94.7%). Regional anesthesia was used in 2,652 patients (55.4%) and was not associated with race or ethnicity (p = 0.287). Compared to White patients, the odds of regional anesthesia use in other racial/ethnic groups were: Asian {odds ratio (OR) 0.851 [95% confidence interval (CI), 0.660–1.097]; p = 0.2125}, Black/African American [OR 0.807 (95% CI, 0.651–1.001); p = 0.0508], Hispanic/Latino [OR 0.957 (95% CI, 0.824–1.154); p = 0.7676], Other race [OR 0.957 (95% CI, 0.627–1.461); p = 0.8376]. In the multivariable analysis, age [OR 0.995 (95% CI, 0.991–1.000); p = 0.0309] and female gender [OR 1.231 (95% CI, 1.090–1.390); p = 0.0008] were associated with the use of regional anesthesia.ConclusionIn this single-institution retrospective study of adults who had undergone major open abdominal surgery, the use of regional anesthesia was not associated with race or ethnicity. In the multivariable analysis, age and female gender were associated with the use of regional anesthesia.

show abstract

Section: Discussionmentioning

confidence: 99%

Race, ethnicity, and the use of regional anesthesia in cancer patients undergoing open abdominal surgery: A single-center retrospective cohort study

et al. 2022

View full text Add to dashboard Cite

show abstract

“… 8 , 25 , 26 In addition to chronic pain, other factors common in patients with OUD such as tobacco use and anxiety have also been associated with increased postoperative pain. 27 Ideally, a multimodal plan for analgesia should be employed for all patients, but especially patients with OUD. This is becoming much more prevalent as enhanced recovery after cesarean delivery (ERAC) protocols are being introduced.…”

Section: Discussionmentioning

confidence: 99%

Analgesic Outcomes in Opioid Use Disorder Patients Receiving Spinal Anesthesia with or without Intrathecal Clonidine for Cesarean Delivery: A Retrospective Investigation

Cook¹,

Kushelev²,

Coffman³

et al. 2022

JPR

View full text Add to dashboard Cite

Background Intrathecal (IT) clonidine has been observed to reduce 24-hour opioid requirements and time to first analgesic request after cesarean delivery, but has not been specifically studied in patients with opioid use disorder (OUD). Methods Patients with OUD undergoing cesarean delivery under spinal or combined spinal-epidural (CSE) anesthesia at our institution from 2011 to 2020 were identified, and only patients with OUD were included in this study. Subjects that received IT clonidine were compared to a control group that did not receive IT clonidine to observe potential differences in analgesic outcomes (24-hour opioid requirements, pain scores and time to first post-operative pain medication) or side-effects (hypotension, vasopressor dosing and bradycardia). Results A total of 160 patients were included (clonidine n = 22, controls n = 138). For the clonidine group, the median IT clonidine dose was 30µg. Clonidine group patients were observed to have greater dose of IT bupivacaine (12 vs 12.75mg; p = 0.01) and IT morphine (100 vs 200µg; p < 0.001). The clonidine group was also observed to have greater incidence of intraoperative hypotension (20% vs 45%; p = 0.01) and maximum phenylephrine dose (50 vs 57.5 µg/min; p < 0.001). The time to first analgesic request (minutes) after surgery was significantly longer for the clonidine group (153.5 vs 207 min; p < 0.001). The average oral oxycodone equivalents taken per 24 hours of hospital admission were significantly less in the clonidine group (82.36 vs 41.67mg; p < 0.001), and the clonidine group also had significantly less oxycodone equivalents taken for each post-operative day. Conclusion IT clonidine was observed to result in reduced 24-hour opioid consumption in patients with OUD and may be useful as part of a multimodal analgesic regimen. The incidence of hypotension and vasopressor doses were greater in patients receiving IT clonidine, and this should be anticipated if IT clonidine is being administered.

show abstract

“…Also, the presence of factors such as chronic pain, smoking, anxiety, race, public insurance, and repeat cesarean delivery has been associated with higher risk of postoperative pain and increased opioid consumption. 103 These considerations are not accounted for by standardized postoperative analgesic protocols. Research is ongoing to identify parturients at risk of developing severe pain and those who are more sensitive to analgesic-related adverse effects to optimize their analgesic regimen.…”

Section: Personalized Analgesiamentioning

confidence: 99%

“…There is significant interindividual variability in pain perception, and preferences in the trade-off between additional analgesics versus the risk of adverse effects after cesarean delivery. Also, the presence of factors such as chronic pain, smoking, anxiety, race, public insurance, and repeat cesarean delivery has been associated with higher risk of postoperative pain and increased opioid consumption 103. These considerations are not accounted for by standardized postoperative analgesic protocols.…”

Section: Personalized Analgesiamentioning

confidence: 99%

Postoperative analgesia after cesarean delivery

Tan

Diomede

Habib

2021

International Anesthesiology Clinics

View full text Add to dashboard Cite

Patient and procedural risk factors for increased postoperative pain after cesarean delivery under neuraxial anesthesia: a retrospective study

Cited by 12 publications

References 25 publications

Race, ethnicity, and the use of regional anesthesia in cancer patients undergoing open abdominal surgery: A single-center retrospective cohort study

Race, ethnicity, and the use of regional anesthesia in cancer patients undergoing open abdominal surgery: A single-center retrospective cohort study

Analgesic Outcomes in Opioid Use Disorder Patients Receiving Spinal Anesthesia with or without Intrathecal Clonidine for Cesarean Delivery: A Retrospective Investigation

Postoperative analgesia after cesarean delivery

Contact Info

Product

Resources

About