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Sangkum L, Chalacheewa T, Tunprasit C, Lavanrattanakul P, Liu H. Predicting the Severity of Acute Pain after Cesarean Delivery: A Narrative Review. Curr Pain Headache Rep 2024:10.1007/s11916-024-01301-y. [PMID: 39042300 DOI: 10.1007/s11916-024-01301-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2024] [Indexed: 07/24/2024]
Abstract
PURPOSE OF THE REVIEW Cesarean delivery is one of the most common surgical procedures performed worldwide. Approximately 28-78% of the patients have reported experiencing severe pain after Cesarean delivery, which is associated with adverse outcomes. Current analgesic management strategies employ a one-size-fits-all approach, which may not be suitable for all post-Cesarean patients. Our ongoing research and the purpose of this review are focusing on preoperative risk assessment to identify patients at risk of severe pain or needing higher doses of opioid or other analgesics. RECENT FINDINGS Recent clinical investigations have found that by utilizing the demographic and psychological evaluations, screening tests, quantitative sensory testing, and assessment of response to local anesthetic infiltration, clinicians were potentially able to stratify the risks for severe post-cesarean pain. Several modalities demonstrated significant correlations with pain outcomes, although most of these correlations were weak to modest. Since consensus statement regarding predicting post-CD pain control are still lacking, these correlations can be clinically helpful. It is possible to identify patients at high risk of developing severe acute pain after cesarean section by preoperative demographic data, screening questionnaires, or other tools. Further studies are needed to identify additional variables or screening tools for more accurate prediction and investigate whether personalized analgesic regimens can lead to improved analgesic outcomes.
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Affiliation(s)
- Lisa Sangkum
- Department of Anesthesiology, Faculty of Medicine, Ramathibodi Hospital Mahidol University, Bangkok, 10400, Thailand
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA
| | - Theerawat Chalacheewa
- Department of Anesthesiology, Faculty of Medicine, Ramathibodi Hospital Mahidol University, Bangkok, 10400, Thailand
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA
| | - Choosak Tunprasit
- Department of Anesthesiology, Faculty of Medicine, Ramathibodi Hospital Mahidol University, Bangkok, 10400, Thailand
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA
| | - Phisut Lavanrattanakul
- Department of Anesthesiology, Faculty of Medicine, Ramathibodi Hospital Mahidol University, Bangkok, 10400, Thailand
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA
| | - Henry Liu
- Department of Anesthesiology, Faculty of Medicine, Ramathibodi Hospital Mahidol University, Bangkok, 10400, Thailand.
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA.
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Kearns RJ, Broom MA, Lucas DN. Long-term effects of neuraxial analgesia. Curr Opin Anaesthesiol 2024; 37:227-233. [PMID: 38390906 DOI: 10.1097/aco.0000000000001365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Abstract
PURPOSE OF REVIEW This review article explores the potential longer-term implications of neuraxial analgesia in labour for both the mother and her child. RECENT FINDINGS Neuraxial techniques for labour analgesia are well tolerated and effective, and long-term adverse sequelae are rare. Labour epidural analgesia is not independently associated with long-term headache, backache, postnatal depression or anal sphincter injury, and evidence supports that epidurals may offer protection against severe maternal morbidity, particularly in women at a higher risk of complications. However, there is an increasing awareness that postdural puncture headache may be associated with chronic headache, back pain and postnatal depression, emphasizing the need for adequate follow-up until symptoms resolve.For the neonate, a growing body of evidence refutes any association between epidural analgesia in labour and the later development of autism spectrum disorder. The clinical significance of epidural related maternal fever remains uncertain and is a research priority. SUMMARY Women should continue to access the significant benefits of neuraxial analgesia in labour without undue concern about adverse sequelae for themselves or their offspring. Measures to prevent, appropriately manage and adequately follow-up women who have suffered complications of neuraxial analgesia, such as postdural puncture headache, are good practice and can mitigate the development of long-term sequelae.
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Affiliation(s)
- Rachel J Kearns
- Princess Royal Maternity Unit
- School of Medicine, University of Glasgow, Glasgow
| | - Malcolm A Broom
- Princess Royal Maternity Unit
- School of Medicine, University of Glasgow, Glasgow
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Tan HS, Tan CW, Sultana R, Chen HY, Chua T, Rahman N, Gandhi M, Sia ATH, Sng BL. The association between epidural labour analgesia and postpartum depression: a randomised controlled trial. Anaesthesia 2024; 79:357-367. [PMID: 37990597 DOI: 10.1111/anae.16178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2023] [Indexed: 11/23/2023]
Abstract
There is conflicting evidence regarding the association between epidural labour analgesia and risk of postpartum depression. Most previous studies were observational trials with limited ability to account for confounders. We aimed to determine if epidural analgesia was associated with a significant change in the incidence of postpartum depression in this randomised controlled trial. We enrolled women aged 21-50 years old with a singleton fetus ≥ 36 weeks gestation. Patients were advised regarding available labour analgesic modalities during enrolment (epidural block; intramuscular pethidine; nitrous oxide; or intravenous remifentanil). On request for analgesia, patients were offered the modality that they had been allocated randomly to first. Blinded investigators recorded patient and obstetric characteristics within 24 h of delivery and assessed for postpartum depression at 6-10 weeks following delivery using the Edinburgh Postnatal Depression Scale (score ≥ 13 considered positive for postpartum depression). The modified intention-to-treat population consisted of all patients who received any form of labour analgesia, while per-protocol consisted of patients who received their randomised modality as their first form of labour analgesia. Of 881 parturients allocated randomly (epidural n = 441, non-epidural n = 440), we analysed 773 (epidural n = 389, non-epidural n = 384); 62 (15.9%) of women allocated to epidural group developed postpartum depression compared with 65 (16.9%) women allocate to the non-epidural group. There were no significant differences in the incidence of postpartum depression between the two groups (adjusted risk difference (95%CI) 1.6 (-3.0-6.3%), p = 0.49). Similar results were obtained with per-protocol analysis (adjusted risk difference (95%CI) -1.0 (-8.3-6.3%), p = 0.79). We found no significant difference in the risk of postpartum depression between patients who received epidural labour analgesia and those who utilised non-epidural analgesic modalities.
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Affiliation(s)
- H S Tan
- Department of Women's Anaesthesia, KK Women's and Children's Hospital, Singapore, Singapore
- Anaesthesiology and Perioperative Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
| | - C W Tan
- Department of Women's Anaesthesia, KK Women's and Children's Hospital, Singapore, Singapore
- Anaesthesiology and Perioperative Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
| | - R Sultana
- Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore, Singapore
| | - H Y Chen
- Department of Psychological Medicine, KK Women's and Children's Hospital, Singapore, Singapore
- Paediatrics Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
| | - T Chua
- Department of Psychological Medicine, KK Women's and Children's Hospital, Singapore, Singapore
- Paediatrics Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
| | - N Rahman
- Department of Biostatistics, Singapore Clinical Research Institute, Singapore, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - M Gandhi
- Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore, Singapore
- Department of Biostatistics, Singapore Clinical Research Institute, Singapore, Singapore
| | - A T H Sia
- Department of Women's Anaesthesia, KK Women's and Children's Hospital, Singapore, Singapore
- Anaesthesiology and Perioperative Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
| | - B L Sng
- Department of Women's Anaesthesia, KK Women's and Children's Hospital, Singapore, Singapore
- Anaesthesiology and Perioperative Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
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Heresco L, Schonman R, Weitzner O, Cohen G, Schreiber H, Daykan Y, Klein Z, Kovo M, Yagur Y. Pain perception and analgesic use after cesarean delivery among women with endometriosis. Eur J Obstet Gynecol Reprod Biol 2024; 294:71-75. [PMID: 38218161 DOI: 10.1016/j.ejogrb.2023.12.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 12/09/2023] [Accepted: 12/25/2023] [Indexed: 01/15/2024]
Abstract
BACKGROUND Patients with endometriosis are known to have altered pain perceptions. Cesarean delivery (CD) is one of the most prevalent surgeries performed worldwide. Appropriate pain control following CD is clinically important to the recovery and relief of patients. This study assessed pain perception and analgesic use after CD among women with or without endometriosis. METHODS This retrospective case control study included women diagnosed with endometriosis, based on clinical or surgical findings, who underwent CD from 2014 to 2022. Controls were matched to the study group by maternal age, BMI (kg/m2), parity, number of previous CDs and by CD indication, in a 2:1 ratio. Post-operative visual analogue scale (VAS) pain scores, on each post-operative day (POD) were compared between groups. Pain intensity was measured and compared using the VAS, range 0 (no pain) to 10 (worst pain). The standard pain relief analgesia protocol in our department includes fixed oral treatment with paracetamol and diclofenac, with the addition of morphine sulphate on POD 0. Analgesic dosages used and the percentage of patients not using the full standard analgesic protocol were compared between groups. RESULTS As compared to controls (n = 142), the endometriosis group (n = 71) was characterized by higher rates of in-vitro fertilization (IVF) pregnancies and previous abdominal surgeries other than CD (p < .001 for both). Other maternal characteristics between groups did not differ. On POD 0, mean morphine dosage was significantly higher in the endometriosis group compared to the control group (24 mg vs. 22.8 mg, respectively; p = .044). More patients in the endometriosis group used the full standard analgesia protocol or more, as compared to controls. VAS scores were not significantly different between groups. CONCLUSIONS Increased use of analgesics after CD was more common among women with endometriosis. These findings imply that pain relief protocols should be personalized for women with endometriosis.
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Affiliation(s)
- Lior Heresco
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel, Affiliated to the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Ron Schonman
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel, Affiliated to the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Omer Weitzner
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel, Affiliated to the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gal Cohen
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel, Affiliated to the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hanoch Schreiber
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel, Affiliated to the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yair Daykan
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel, Affiliated to the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Zvi Klein
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel, Affiliated to the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michal Kovo
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel, Affiliated to the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yael Yagur
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel, Affiliated to the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Abdel-Fatah Ibrahim H, Alshahrani MS, Al-Qinnah AJ, Elgzar WT. Nonpharmacological pain relief for labour pain: knowledge, attitude, and barriers among obstetric care providers. PeerJ 2024; 12:e16862. [PMID: 38317843 PMCID: PMC10840495 DOI: 10.7717/peerj.16862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 01/09/2024] [Indexed: 02/07/2024] Open
Abstract
Background Labor pain is considered the worst pain in a woman's life. Hence, pain control should be essential to labor management at any level. There is scarce information, and there are gaps regarding the knowledge, attitude, and barriers to the utilization of nonpharmacological approaches for pain relief in Saudi Arabia. Therefore, the current study aims to evaluate nonpharmacological pain relief (NPPR)-related knowledge, attitudes, and barriers among obstetric care providers in Najran, Saudi Arabia. Methods A cross-sectional analytical study was performed at maternity departments in Maternal and Children Hospital (MCH), Najran, Saudi Arabia, from April 1 to May 26 2023. The study involved 186 obstetric care providers (OPCs), physicians (19), nurses (144), and midwives (23). A structured self-reported questionnaire was used to collect data and involves five main sections: demographic data, work-related data, nonpharmacological pain relief-related attitude, perceived barriers, and knowledge quiz. The adjusted odds ratio (AOR) along with 95% CI was estimated to determine the factors associated with nonpharmacological pain relief-related knowledge and attitude using multivariate analysis in the binary logistic regression. Results Over three-quarters (79%) of obstetric care providers had adequate knowledge of nonpharmacological pain relief methods. The majority (85.5%) of the participants had a positive attitude toward NPPR in labour pain management, with the mean scores ranging from 3.55-4.23 for all sub-items. Obstetric care providers acknowledged that patient belief, lack of time, and workload were the strongest barriers to offering nonpharmacological pain relief methods for labour pain 67.6%, 64.5%, and 61.3%, respectively. In binary logistic regression analysis, the in-service training related to nonpharmacological pain relief (AOR = 5.871 (2.174-15.857), p = 0.000), (AOR = 3.942 (1.926-11.380), p = 0.013) and years of work experience (AOR = 1.678 (1.080-2.564), p = 0.019), (AOR = 1.740 (1.188-2.548), p = 0.003) were significantly associated with obstetric care providers' knowledge and attitudes regarding nonpharmacological pain relief (p ≤ 0.05). Conclusion Although most OPCs have adequate knowledge and a positive attitude regarding NPPR, they need motivational strategies to enhance their utilization. In addition, an effort should be made to decrease OPCs' workload to provide more time for NPPR application and patient education. Training courses and in-service training can play an important role in enhancing NPPR knowledge and attitude and, consequently, its application. Also, in each working unit, the policymakers should provide clear guidelines and policies that enhance and control the utilization of NPPR.
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Affiliation(s)
- Heba Abdel-Fatah Ibrahim
- Department of Maternity and Childhood Nursing, Nursing College, Najran University, Najran, Saudi Arabia
| | - Majed Said Alshahrani
- Department of Obstetrics and Gynecology, College of Medicine, Najran University, Najran, Saudi Arabia
| | | | - Wafaa Taha Elgzar
- Department of Maternity and Childhood Nursing, Nursing College, Najran University, Najran, Saudi Arabia
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Aksoy SD, Odabas RK, Gul DK. Acupressure application to relieve postpartum uterus pain during breastfeeding: A randomized controlled study. Explore (NY) 2023; 19:710-717. [PMID: 36849298 DOI: 10.1016/j.explore.2023.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 02/06/2023] [Accepted: 02/10/2023] [Indexed: 02/27/2023]
Abstract
OBJECTIVE Postpartum uterus pain while breastfeeding is a situation that can affect mother-infant bonding negatively and is a matter of concern for women. The purpose of this study is to investigate the effectiveness of acupressure application in reducing postpartum uterus pain during breastfeeding. METHODS This prospective randomized controlled trial was carried out at a maternity hospital in northwestern Turkey between March and August 2022. The sample of the study included 125 multiparous women who were in the 6th to 24th hours after vaginal delivery. The participants were randomly divided into acupressure and control groups. Visual Analog Scale (VAS) was used to evaluate postpartum uterine pain. RESULTS While the VAS scores of the acupressure and control groups were similar before breastfeeding, the scores of the acupressure group at the 10th and 20th minutes of breastfeeding were lower (respectively, p = 0.038 and p = 0.011). In the intragroup comparisons, compared to their values before breastfeeding, the pain score of the acupressure group decreased at a statistically highly significant degree at the 20th minute of breastfeeding (p<0.001), whereas the score of the control group increased at a statistically highly significant degree at the 10th and 20th minutes (p<0.001). CONCLUSION It was concluded that acupressure can be an effective nonpharmacological method in reducing uterus pain while breastfeeding in the postpartum period.
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Affiliation(s)
- Sena Dilek Aksoy
- Deparment of Midwifery, Faculty of Health Science, Kocaeli University, Kocaeli, Turkey.
| | - Resmiye Kaya Odabas
- Deparment of Midwifery, Faculty of Health Science, Kocaeli University, Kocaeli, Turkey
| | - Derya Kanza Gul
- School of Medicine Health, Medipol University, Istanbul, Turkey
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