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Oweidat A, Kalagara H, Sondekoppam RV. Current concepts and targets for preventing the transition of acute to chronic postsurgical pain. Curr Opin Anaesthesiol 2024:00001503-990000000-00220. [PMID: 39087396 DOI: 10.1097/aco.0000000000001424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2024]
Abstract
PURPOSE OF THE REVIEW It is estimated that approximately a third of patients undergoing certain surgeries may report some degree of persistent pain postoperatively. Chronic postsurgical pain (CPSP) reduces quality of life, is challenging to treat, and has significant socio-economic impact. RECENT FINDINGS From an epidemiological perspective, factors that predispose patients to the development of CPSP may be considered in relation to the patient, the procedure or, the care environment. Prevention or management of transition from acute to chronic pain often need a multidisciplinary approach beginning early in the preoperative period and continuing beyond surgical admission. The current concepts regarding the role of central and peripheral nervous systems in chronification of pain may provide targets for future therapies but, the current evidence seems to suggest that a multimodal analgesic approach of preventive analgesia along with a continued follow-up and treatment after hospital discharge may hold the key to identify and manage the transitioning of acute to chronic pain. SUMMARY A comprehensive multidisciplinary approach with prior identification of risk factors, minimizing the surgical insult and a culture of utilizing multimodal analgesia and continued surveillance beyond the period of hospitalization is an important step towards reducing the development of chronic pain. A transitional pain service model may accomplish many of these goals.
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Affiliation(s)
- Adeeb Oweidat
- Department of Anesthesia, University of Iowa Healthcare, Iowa City, Iowa
| | - Hari Kalagara
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, Florida, USA
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Gurmu M, Mulugeta H, Zemedkun A, Girma T, Destaw B, Tadessa M, Adamu Y, Hailu S. Postoperative analgesic effects of intravenous dexamethasone for patients undergoing cesarean delivery under spinal anesthesia at Dilla University Referral Hospital, Ethiopia, 2023: a double-blind randomized controlled trial. Ann Med Surg (Lond) 2024; 86:232-239. [PMID: 38222682 PMCID: PMC10783290 DOI: 10.1097/ms9.0000000000001563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 11/20/2023] [Indexed: 01/16/2024] Open
Abstract
Background The use of cesarean section (CS) worldwide has increased to unprecedented levels. In Ethiopia, the CS delivery rate is above the rate recommended by the WHO. The postoperative pain experience is moderate to severe in most patients during their postoperative period. The administration of intravenous dexamethasone is thought to have an analgesic effect after surgery even though the analgesic profile of preoperatively administered dexamethasone is less addressed. Objective This study aimed to assess the postoperative analgesic effect of preoperative intravenous dexamethasone for patients undergoing cesarean delivery under spinal anesthesia at Dilla University Referral Hospital, Southern Ethiopia. Methodology A double-blinded randomized controlled trial (RCT) was done on 112 patients undergoing elective CS under spinal anesthesia who were allocated randomly into normal saline and dexamethasone groups. Total analgesic consumption, time to first analgesic request, and postoperative pain score with the numerical rating scale (NRS) were followed for 24 h in both groups. Shapiro-Wilk tests were used to check normality. Independent samples t-test was used for the comparison of means between groups, Mann-Whitney U test for non-normally distributed data, and χ 2 test for categorical variables, and P-value <0.05 was considered statistically significant with a power of 80%. Result The finding of this study showed that the postoperative pain score of the dexamethasone group was significantly lower than the normal saline group at 2, 4, 6, 12, 18, and 24 h with a statistically significant P-value <0.05. There was also a significant difference in the time to the first rescue analgesic request between the two groups, with the dexamethasone group (median=347.5 min) and the normal saline group (median=230 min) with P=0.001. Conclusion and recommendation The authors conclude that preoperative administration of 8 mg of dexamethasone prolongs the first analgesic request time, decreases postoperative tramadol and diclofenac consumption, and decreases the postoperative pain score. The authors recommend that researchers conduct further RCTs with a different dose of dexamethasone and on a multicenter basis.
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Affiliation(s)
| | | | | | | | | | | | | | - Seyoum Hailu
- Department of Anesthesiology, Dilla University, Dilla, Ethiopia
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Hussein A, Torky H, Aly R, Abdel-Rasheed M, El-Baz A, Mahmoud H, Sileem S, Badawy M, Sayd Z, Dief O, Elsadek A, Marie H, Abo-Louz A. Lidocaine vs. tramadol vs. placebo wound infiltration for post-cesarean section pain relief: a randomized controlled trial. J Perinat Med 2022; 50:1073-1077. [PMID: 35531757 DOI: 10.1515/jpm-2021-0624] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 04/11/2022] [Indexed: 02/05/2023]
Abstract
OBJECTIVES In low-income settings, postoperative pain relief could be challenging as a high patient/nurse ratio limits pain assessment and adequate analgesics administration. The multi-center prospective double-blinded parallel randomized controlled trial was done to compare lidocaine, tramadol, and placebo (saline) intraoperative wound infiltration to relieve post-cesarean section wound pain during the first 24 h. METHODS Ninety-nine cases were equally randomized into three groups, each containing 33 pregnant women undergoing cesarean section under general anesthesia. During operation, the wound was infiltrated subcutaneously with 20 mL of 2% lidocaine solution in the first group, 2 mg/kg tramadol in the second group, and saline in the third group. The primary outcome was to assess the postoperative pain at 2, 4, 6, 12, and 24 h by the Yes-No-Don't Know (YNDK) Scale, while the secondary outcome was to assess the need for further postoperative analgesia. RESULTS Wound infiltration with lidocaine or tramadol was effective in pain relief, and both were superior to placebo. Wound infiltration with tramadol was superior to lidocaine in pain relief at 2 h and up to 24 h. CONCLUSIONS Wound infiltration with tramadol has a more prolonged pain relief effect than lidocaine in post-cesarean section pain relief in patients performing cesarean section under general anesthesia lasting up to 24 h, and both are superior to placebo in pain relief.
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Affiliation(s)
- Ahmed Hussein
- Department of Obstetrics & Gynecology, October 6th University, Giza, Egypt
| | - Haitham Torky
- Department of Obstetrics & Gynecology, October 6th University, Giza, Egypt
| | - Rania Aly
- Department of Obstetrics & Gynecology, Al-Galaa Teaching Hospital, Cairo, Egypt
| | - Mazen Abdel-Rasheed
- Department of Reproductive Health Research, National Research Centre, Giza, Egypt
| | - Ashraf El-Baz
- Department of Obstetrics & Gynecology, Al-Galaa Teaching Hospital, Cairo, Egypt
| | - Hossam Mahmoud
- Department of Obstetrics & Gynecology, Al-Galaa Teaching Hospital, Cairo, Egypt
| | - Sileem Sileem
- Department of Obstetrics & Gynecology, Al-Azhar University, Assiut, Egypt
| | - Mahmoud Badawy
- Department of Obstetrics & Gynecology, Al-Azhar University, Assiut, Egypt
| | - Zainab Sayd
- Department of Obstetrics & Gynecology, Al-Azhar University, Assiut, Egypt
| | - Osama Dief
- Department of Obstetrics & Gynecology, Al-Azhar University, Cairo, Egypt
| | - Ahmed Elsadek
- Department of Obstetrics & Gynecology, Al-Azhar University, Cairo, Egypt
| | - Heba Marie
- Department of Obstetrics & Gynecology, Cairo University, Cairo, Egypt
| | - Ashraf Abo-Louz
- Department of Obstetrics & Gynecology, October 6th University, Giza, Egypt
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Azanu WK, Osarfo J, Larsen-Reindorf RE, Agbeno EK, Dassah E, Amanfo AO, Dah AK, Ampofo G. Assessment and determinants of acute post-caesarean section pain in a tertiary facility in Ghana. PLoS One 2022; 17:e0268947. [PMID: 35613148 PMCID: PMC9132330 DOI: 10.1371/journal.pone.0268947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 05/11/2022] [Indexed: 11/19/2022] Open
Abstract
Introduction
Caesarean sections (CS) feature prominently in obstetric care and have impacted positively on maternal / neonatal outcomes globally including Ghana. However, in spite of documented increasing CS rates in the country, there are no studies assessing the adequacy of post-CS pain control. This study assessed the adequacy of post-CS pain management as well as factors influencing this outcome. Additionally, post-CS analgesia prescription and serving habits of doctors and nurses were also described to help fill existing knowledge gaps.
Methods
Pain scores of 400 randomly selected and consenting post-CS women at a tertiary facility in Ghana were assessed at 6–12 hours post-CS at rest and with movement and at 24–36 hours post-CS with movement using a validated visual analog scale (VAS) from February 1, 2015 to April 8, 2015. Participant characteristics including age, marital status and duration of CS were obtained using pretested questionnaires and patient records review. Descriptive statistics were presented as frequencies and proportions. Associations between background characteristics and the outcome variables of adequacy of pain control at 6–12 hours post-CS at rest and with movement and at 24–36 hours post-CS with movement were analysed using Chi-square and Fisher’s exact tests and logistic regression methods. Adequate pain control was defined as VAS scores ≤5.
Results
At 6–12 hours post-CS (at rest), equal proportions of participants had adequate and inadequate pain control (50.1% vrs 49.9%). Over the same time period but with movement, pain control was deemed inadequate in 93% of respondents (369/396). Women who had one previous surgery [OR 0.47 95%CI 0.27, 0.82; p = 0.008] and those whose CS lasted longer than 45 mins [OR 0.39 95% CI 0.24, 0.62; p<0.001] had lower odds of reporting adequate pain control. Women prescribed 12-hourly and 8-hourly doses of pethidine had only 23.5% (12/51) and 10.3% (3/29) served as prescribed respectively. At 24–36 hours post CS, adequate pain control was reported by 85.3% (326/382) of participants.
Conclusions
Pain management was deemed inadequate within the first 12 hours post-CS with potential implications for early mother-child interaction. Appreciable numbers of participants did not have their analgesics served as prescribed. Adjunct pain control measures should be explored and healthcare workers must be encouraged to pay more attention to patients’ pain relief needs.
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Affiliation(s)
- Wisdom Klutse Azanu
- Department of Obstetrics and Gynaecology, School of Medicine, University of Health and Allied Sciences, Ho, Ghana
| | - Joseph Osarfo
- Department of Community Medicine, School of Medicine, University of Health and Allied Sciences, Ho, Ghana
- * E-mail: ,
| | - Roderick Emil Larsen-Reindorf
- Department of Obstetrics and Gynaecology, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- Department of Population, Family and Reproductive Health, School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Evans Kofi Agbeno
- Department of Obstetrics and Gynaecology, School of Medical Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Edward Dassah
- Department of Population, Family and Reproductive Health, School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Anthony Ofori Amanfo
- Department of Obstetrics and Gynaecology, School of Medical Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Anthony Kwame Dah
- Department of Obstetrics and Gynaecology, School of Medicine, University of Health and Allied Sciences, Ho, Ghana
| | - Gifty Ampofo
- Department of Community Medicine, School of Medicine, University of Health and Allied Sciences, Ho, Ghana
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Aga A, Abrar M, Ashebir Z, Seifu A, Zewdu D, Teshome D. The use of perineural dexamethasone and transverse abdominal plane block for postoperative analgesia in cesarean section operations under spinal anesthesia: an observational study. BMC Anesthesiol 2021; 21:292. [PMID: 34809573 PMCID: PMC8607620 DOI: 10.1186/s12871-021-01513-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 11/05/2021] [Indexed: 11/26/2022] Open
Abstract
Background During transverses abdominal plane block (TAP) procedure to provide analgesia in cesarean section (CS) operation, the use of perineural dexamethasone as an additive agent may improve pain relief and may cause a prolonged block duration. This study aims to investigate whether perineural dexamethasone, when added to bupivacaine local anesthetic agent during a TAP block, may provide adequate pain relief without adverse events. Methods This is a prospective cohort study of fifty-eight patients undergoing elective CS with spinal anesthesia. We hypothesized to perform bilateral TAP block using perineural dexamethasone as an additive agent. The patients were randomly divided into two groups using a systematic random sampling method. While one group of patients received perineural dexamethasone of 8 mg additive agent together with bupivacaine 0.25% 40 ml (Group TAPD), the other group received only bupivacaine 0.25% 40 ml in TAP block (Group TAPA). The primary outcomes are the period for the first request of postoperative pain relief medication and the numerical rating scale (NRS) pain intensity scores at 2, 6, 12, and 24 h after surgery. The secondary outcomes are comparing the 24-h tramadol and diclofenac analgesic requirements and the incidences of side effects on postoperative day one. A p-value of < 0.05 is statistically significant. Results The time to first analgesic request was 8.5 h (8.39–9.79) in the TAPD group versus 5.3 h (5.23–5.59) in the TAPA group, respectively. (p < 0.001) The median NRS scores were significantly reduced in the TAPD group compared to the TAPA group at 6, 12, and 24 h after surgery (p-values < 0.001). The total analgesics consumption over 24 h postoperatively was lower in Group TAPD compared to Group TAPA (p < 0.05). Conclusion An additive agent of perineural dexamethasone at a dose of 8 mg during bilateral TAP block for elective CS operation under spinal anesthesia provided better pain relief on postoperative day 1.
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Affiliation(s)
- Abdisa Aga
- Department of Anesthesia, Harar College of Health Science, Harar, Ethiopia
| | - Meron Abrar
- Department of Anesthesia, College of Health Science, Addis Ababa University, Addis Ababa, Ethiopia
| | - Zewetir Ashebir
- Department of Anesthesia, College of Health Science, Addis Ababa University, Addis Ababa, Ethiopia
| | - Ashenafi Seifu
- Department of Anesthesia, College of Health Science, Addis Ababa University, Addis Ababa, Ethiopia
| | - Dereje Zewdu
- Department of Anesthesia, College of Health Science, Wolkite University, PO. Box: 1362, Wolkite, Ethiopia.
| | - Diriba Teshome
- Department of Anesthesia, College of Health Science, Debre Tabor University, Debre Tabor, Ethiopia
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Perioperative factors associated with persistent post-surgical pain after hysterectomy, cesarean section, prostatectomy, and donor nephrectomy: a systematic review and meta-analysis. Pain 2021; 163:425-435. [PMID: 34121077 DOI: 10.1097/j.pain.0000000000002361] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 05/04/2021] [Indexed: 11/26/2022]
Abstract
ABSTRACT Persistent postsurgical pain (PPSP) is a common, and often disabling postoperative morbidity, but many questions remain about factors associated with PPSP. This systematic review and meta-analysis aimed to identify preoperative, intraoperative and postoperative factors associated with PPSP after gynecological surgeries, namely hysterectomy and cesarean section (C-section), and urological surgeries, namely prostatectomy and donor nephrectomy. Overall, 18 gynecological surgery studies, 4 prostatectomy studies, and 2 donor nephrectomy studies met the review criteria providing data that could be meta-analyzed. Average (±SD) PPSP occurrence after gynecological surgery was 20±11%; factors associated with increased risk of PPSP included smoking, preoperative abdominal or pelvic pain, preoperative pain elsewhere in the body, longer duration of surgery, more intense acute postoperative pain, and surgical wound infection. The use of neuraxial anesthesia was associated with decreased PPSP risk. Average PPSP occurrence was 20±9% after prostatectomy and 15±2% after donor nephrectomy. For urological procedures, the existing data did not allow for identification of significant factors associated with PPSP, except for laparoscopic and hand assisted laparoscopic approaches that were associated with lower incidence of PPSP for donor nephrectomy, and the use of neuraxial anesthesia which was associated with lower incidence of PPSP after prostatectomy. PPSP after gynecological and urological surgeries is common. This systematic review identified important factors associated with C-section and hysterectomy that can help identify women who are at high risk of PPSP. More high-quality studies with consistent methodology are needed to understand the factors associated with PPSP risk, particularly for surgeries such as prostatectomy and nephrectomy.
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Ma S, Zhang Y, Li Q. Magnesium sulfate reduces postoperative pain in women with cesarean section: A meta-analysis of randomized controlled trials. Pain Pract 2021; 22:8-18. [PMID: 33896098 DOI: 10.1111/papr.13022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 03/01/2021] [Accepted: 03/18/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The use of magnesium sulfate (MgSO4 ) as an adjunct in different anesthetic regimens for cesarean section (CS) delivery often reports conflicting results. This study aimed to review the effectiveness of MgSO4 on improving postoperative analgesia after CS systematically. METHODS PubMed, Embase, and the Cochrane library were searched for randomized controlled trials (RCTs) published from inception to February 2020. RESULTS A total of 880 women were included (440 in each group). MgSO4 had a statistically significant effect compared to the control group on the highest VAS (weighted mean difference [WMD] = -0.74, 95% confidence interval [CI] = -1.03 to -0.46, p < 0.001, I2 = 91.7%, pheterogeneity < 0.001) and the last VAS (WMD = -0.47, 95% CI = -0.71 to -0.23, p < 0.001, I2 = 95.0%, pheterogeneity < 0.001). MgSO4 prolonged the time to the first use of analgesia compared to the control group (standardized mean difference [SMD] = -3.03 min, 95% CI = -4.32 to -1.74, p < 0.001, I2 = 96.3%, pheterogeneity < 0.001). MgSO4 decreased the consumption of analgesia compared to the control group (SMD = -3.20 mg of IV morphine equivalent, 95% CI: -5.45 to -0.95, p = 0.005, I2 = 97.6%, pheterogeneity < 0.001). DISCUSSION MgSO4 decreases the highest VAS in women who underwent general anesthesia, spinal anesthesia, or epidural for CS (all p < 0.05). Additional MgSO4 significantly reduces postoperative pain in women undergoing CS.
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Affiliation(s)
- Siguang Ma
- Anesthesia Department, Tianjin Central Obstetrics and Gynecology Hospital, Tianjin, China.,Tianjin Key Laboratory of Human Development and Reproductive Expansion, Tianjin, China
| | - Yanju Zhang
- Anesthesia Department, Tianjin Central Obstetrics and Gynecology Hospital, Tianjin, China.,Tianjin Key Laboratory of Human Development and Reproductive Expansion, Tianjin, China
| | - Qian Li
- Anesthesia Department, Tianjin Central Obstetrics and Gynecology Hospital, Tianjin, China.,Tianjin Key Laboratory of Human Development and Reproductive Expansion, Tianjin, China
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8
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Effectiveness of wound site infiltration for parturients undergoing elective cesarean section in an Ethiopian hospital: A prospective cohort study. Ann Med Surg (Lond) 2021; 64:102255. [PMID: 33898028 PMCID: PMC8053795 DOI: 10.1016/j.amsu.2021.102255] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 03/20/2021] [Accepted: 03/22/2021] [Indexed: 11/21/2022] Open
Abstract
Background Cesarean delivery (CD) is a commonly performed obstetric surgical procedure and causes moderate to severe postoperative pain. Wound site infiltration (WSI) is becoming a technique to provide postoperative analgesia in a limited-resource setting in regardless of controversy on its effectiveness. The current study is to assess its effectiveness as a part of postoperative analgesia for parturients undergoing elective Cesarean section. Methods A Hospital-based prospective cohort study was employed on 58 parturients that underwent elective Cesarean section. Study participants were allocated into the Wound site infiltration and Control group based on planned postoperative pain management. A student t-test was used for normally distributed data while non-normally distributed data were analyzed by Mann Whitney U test. Pearson Chi-squared or Fisher's exact test were used to analyzing categorical data as appropriate. A p-value < 0.05 considered as statistically significant. Results The median time to request the first analgesia was significantly prolonged within Wound site infiltration 314.31 ± 47.71 in minutes compared to control group 216.9 ± 43.18 with a P-value of <0.001. The postoperative verbal NRS score was significantly reduced in Wound site infiltration compared to the control group at 4th and 6th hours with p values of <0.001 and 0.04 respectively. Conclusion Wound site infiltration performed following elective cesarean section under spinal anesthesia significantly prolonged time to request the first analgesia, decreases verbal NRS score, and total analgesic consumption within 24 h in postoperative period compared to control group. WSI might prolong duration of analgesia for cesarean section. WSI might decrease postoperative pain severity for cesarean section. WSI might reduce total analgesic consumption within 24 h in postoperatively.
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Nimmaanrat S, Wongwiwattananon W, Siripreukpong S, Chongsuvivatwong V, Jensen MP. A prospective observational study to investigate the relationship between local anesthetic infiltration pain before spinal anesthesia and acute and chronic postsurgical pain in women undergoing elective cesarean delivery. Int J Obstet Anesth 2020; 45:56-60. [PMID: 33293186 DOI: 10.1016/j.ijoa.2020.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 10/20/2020] [Accepted: 11/09/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Cesarean delivery is one of the most common procedures performed worldwide. We conducted this prospective cohort study to evaluate the association between local anesthetic infiltration (LAI) pain prior to spinal anesthesia and pain and morphine consumption within 24 h after cesarean delivery (primary outcomes). A secondary objective was to assess the association between LAI pain and pain at one month postoperatively. METHODS Recruitment of 216 eligible women scheduled for elective cesarean delivery. Local infiltration before spinal anesthesia was performed using a 24-gauge needle and 3 mL 2% plain lidocaine. All subjects received 2.2 mL 0.5% hyperbaric bupivacaine with 200 µg morphine for spinal anesthesia. A 0-10 verbal numerical rating scale was used to assess LAI pain severity, and subsequent pain at 24 h, 1, 3 and 12 months. RESULTS We found a moderate correlation between LAI pain intensity and severity of acute pain at rest (rho=0.56, P <0.001) and with movement (rho=0.58, P <0.001) and a weak correlation with morphine consumption (rho=0.17, P=0.01) within 24 h postoperatively. We also found a positive correlation between LAI pain and the severity of persistent wound pain at rest (rho=0.30, P <0.001) and with movement (rho=0.52, P <0.001) at 1 month. The incidence of wound pain at 1, 3 and 12 months postoperatively was 37.1%, 7.0% and 1.4%, respectively. CONCLUSIONS Pain from LAI prior to spinal anesthesia is significantly associated with subsequent postoperative pain both acutely and at one month in women scheduled for elective cesarean delivery under spinal anesthesia.
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Affiliation(s)
- S Nimmaanrat
- Department of Anesthesiology, Faculty of Medicine, Prince of Songkla University, Hatyai, Songkhla, Thailand.
| | - W Wongwiwattananon
- Department of Anesthesiology, Faculty of Medicine, Prince of Songkla University, Hatyai, Songkhla, Thailand
| | - S Siripreukpong
- Department of Anesthesiology, Faculty of Medicine, Prince of Songkla University, Hatyai, Songkhla, Thailand
| | - V Chongsuvivatwong
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hatyai, Songkhla, Thailand
| | - M P Jensen
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA, USA
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Borges NC, de Deus JM, Guimarães RA, Conde DM, Bachion MM, de Moura LA, Pereira LV. The incidence of chronic pain following Cesarean section and associated risk factors: A cohort of women followed up for three months. PLoS One 2020; 15:e0238634. [PMID: 32886704 PMCID: PMC7473578 DOI: 10.1371/journal.pone.0238634] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 08/20/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Chronic post-surgical pain (CPSP) is one of the post-surgical complications of a Cesarean section. Despite the high rates of Cesarean section worldwide, the incidence of CPSP and the risk factors for this condition remain relatively unknown. The objective of this study was to calculate the incidence of CPSP in women submitted to Cesarean section and to analyze the associated risk factors. MATERIALS AND METHODS A prospective cohort of 621 women undergoing Cesarean section was recruited preoperatively. Potential presurgical (sociodemographic, clinical and lifestyle-related characteristics) and post-surgical risk factors (the presence and intensity of pain) risk factors were analyzed. Pain was measured at 24 hours and 7, 30, 60 and 90 days after surgery. Following discharge from hospital, data were collected by telephone. The outcome measure was self-reported pain three months after a Cesarean section. The risk factors for chronic pain were analyzed using the log-binomial regression model (a generalized linear model). RESULTS A total of 462 women were successfully contacted 90 days following surgery. The incidence of CPSP was 25.5% (95%CI: 21.8-29.7). Risk factors included presurgical anxiety (adjusted relative risk [RR] 1.03; 95%CI: 1.01-1.05), smoking (adjusted RR 2.22; 95%CI: 1.27-3.88) and severe pain in the early postoperative period (adjusted RR 2.79; 95%CI: 1.29-6.00). CONCLUSION One in four women submitted to Cesarean section may develop CPSP; however, the risk factors identified here are modifiable and preventable. Preventive strategies directed towards controlling anxiety, reducing smoking during pregnancy and managing pain soon after hospital discharge are recommended.
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Affiliation(s)
| | - José Miguel de Deus
- Department of Obstetrics and Gynecology, Federal University of Goiás, Goiânia, Goiás, Brazil
| | | | - Délio Marques Conde
- Department of Obstetrics and Gynecology, Federal University of Goiás, Goiânia, Goiás, Brazil
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Komatsu R, Ando K, Flood PD. Factors associated with persistent pain after childbirth: a narrative review. Br J Anaesth 2020; 124:e117-e130. [PMID: 31955857 PMCID: PMC7187795 DOI: 10.1016/j.bja.2019.12.037] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Revised: 12/26/2019] [Accepted: 12/28/2019] [Indexed: 12/12/2022] Open
Abstract
A systematic literature search was performed to identify studies that reported risk factors for persistent pain after childbirth. Many studies have sought to identify risk factors for post-delivery pain in different populations, using different methodologies and different outcome variables. Studies of several different but interrelated post-partum pain syndromes have been conducted. Factors strongly and specifically associated with persistent incisional scar pain after Caesarean delivery include a coexisting persistent pain problem in another part of the body and severe acute postoperative pain. For persistent vaginal and perineal pain, operative vaginal delivery and the magnitude of perineal trauma have been consistently linked. History of pregnancy-related and pre-pregnancy back pain and heavier body weight are robust risk factors for persistent back pain after pregnancy. Unfortunately, limitations, particularly small samples and lack of a priori sample size calculation designed to detect specific effect sizes for risk of persistent pain outcomes, preclude definitive conclusions about many other predictors and the strength of outcome associations. In future studies, assessments of specific phenotypes using a rigorous analysis with appropriate predetermined sample sizes and validated instruments are needed to allow elucidation of stronger and reliable associations. Interventional studies targeting the most robustly associated, modifiable risk factors, such as acute post-partum pain, may lead to solutions for the prevention and treatment of these common problems that impact a large population.
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Affiliation(s)
- Ryu Komatsu
- Department of Anaesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA.
| | - Kazuo Ando
- Department of Anaesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Pamela D Flood
- Department of Anaesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
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Grubb T, Lobprise H. Local and regional anaesthesia in dogs and cats: Overview of concepts and drugs (Part 1). Vet Med Sci 2020; 6:209-217. [PMID: 31965742 PMCID: PMC7196681 DOI: 10.1002/vms3.219] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Accepted: 10/27/2019] [Indexed: 11/23/2022] Open
Abstract
Pain management in veterinary patients is a crucial component of appropriate patient care. Multimodal analgesia that includes both systemically and locally/regionally administered drugs is generally the most effective approach to providing pain relief. Local anaesthetic drugs used in local and regional blockade are unique in that they can completely block the transmission of pain (in conscious patients) or nociceptive (in anaesthetized patients) signals, thereby providing profound analgesia. In addition, local and regional administration of drugs, when compared with systemic bolus administration, generally results in a lower incidence of dose‐related adverse effects. Due to the potential to provide profound analgesia and the high safety margin (when used correctly) of this drug class, local anaesthetics are recommended as part of the analgesic protocol in the majority of patients undergoing surgical procedures or suffering traumatic injuries. This manuscript, Part 1 of a two‐part instalment, emphasizes the importance of using local and regional anaesthesia as a component of multimodal analgesia, provides a review of the basic pharmacokinetics/pharmacodynamics of local anaesthetic drugs in general, lists information on commonly used local anaesthetic drugs for local and regional blockade in dogs and cats, and briefly introduces the novel liposome‐encapsulated bupivacaine (NOCITA®). Part 2 is a review of local and regional anaesthetic techniques used in dogs and cats (Grubb & Lobprise, 2020).
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Intraoperative methadone administration and postoperative pain control: a systematic review and meta-analysis. Pain 2019; 161:237-243. [DOI: 10.1097/j.pain.0000000000001717] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Sun KW, Pan PH. Persistent pain after cesarean delivery. Int J Obstet Anesth 2019; 40:78-90. [PMID: 31281032 DOI: 10.1016/j.ijoa.2019.06.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 05/01/2019] [Accepted: 06/03/2019] [Indexed: 01/22/2023]
Abstract
The incidence of persistent pain after cesarean deliveries (CD) varies but is much lower than after comparable surgeries. However, with over four million deliveries annually and a rising CD rate, even a low prevalence of persistent pain after CD impacts many otherwise healthy young women. Consideration of the pathophysiology of persistent pain after surgery and the risk factors predisposing women to persistent and chronic pain after CD provides insights into the prevention and treatment of persistent pain; and improves the quality of care and recovery after CD. The findings that the peripartum state and oxytocin confer protection against persistent pain may provide new and interesting perspectives for the prevention and treatment of chronic pain caused by trauma or surgery. Predictive tools available to identify and target patients at high risk of acute and chronic pain have mostly weak to modest predictive correlations and many are either not clinically feasible or too time-consuming to apply. Persistent pain has been linked to the severity of acute postoperative pain and opioid exposure. Modified surgical techniques, neuraxial anesthesia and opioid-sparing analgesia may help limit the development of persistent and chronic pain. The goal of this narrative review is to examine the incidence of persistent pain after CD; review briefly the underlying pathophysiology of persistent pain and the transition from acute to chronic pain (with particular emphasis on the uniqueness after CD); and to review modifiable risk factors and prevention strategies that identify at-risk patients and allow tailored treatment.
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Affiliation(s)
- K W Sun
- Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - P H Pan
- Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, NC, USA.
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Yimer H, Woldie H. Incidence and Associated Factors of Chronic Pain After Caesarean Section: A Systematic Review. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 41:840-854. [DOI: 10.1016/j.jogc.2018.04.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Revised: 04/05/2018] [Accepted: 04/09/2018] [Indexed: 10/28/2022]
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Kintu A, Abdulla S, Lubikire A, Nabukenya MT, Igaga E, Bulamba F, Semakula D, Olufolabi AJ. Postoperative pain after cesarean section: assessment and management in a tertiary hospital in a low-income country. BMC Health Serv Res 2019; 19:68. [PMID: 30683083 PMCID: PMC6347795 DOI: 10.1186/s12913-019-3911-x] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 01/17/2019] [Indexed: 11/29/2022] Open
Abstract
Background There is little information about the current management of pain after obstetric surgery at Mulago hospital in Uganda, one of the largest hospitals in Africa with approximately 32,000 deliveries per year. The primary goal of this study was to assess the severity of post cesarean section pain. Secondary objectives were to identify analgesic medications used to control post cesarean section pain and resultant patient satisfaction. Methods We prospectively followed 333 women who underwent cesarean section under spinal anesthesia. Subjective assessment of the participants’ pain was done using the Visual Analogue Scale (0 to 100) at 0, 6 and 24 h after surgery. Satisfaction with pain control was ascertained at 24 h after surgery using a 2-point scale (yes/no). Participants’ charts were reviewed for records of analgesics administered. Results Pain control medications used in the first 24 h following cesarean section at this hospital included diclofenac only, pethidine only, tramadol only and multiple pain medications. There were mothers who did not receive any analgesic medication. The highest pain scores were reported at 6 h (median: 37; (IQR:37.5). 68% of participants reported they were satisfied with their pain control. Conclusion Adequate management of post-cesarean section pain remains a challenge at Mulago hospital. Greater inter-professional collaboration, self-administered analgesia, scheduled prescription orders and increasing availability of analgesic drugs may contribute to improved treatment of postoperative pain with better pain scores.
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Affiliation(s)
- Andrew Kintu
- Department of Anesthesia, Makerere University College of Health Sciences, Mulago, Uganda.
| | - Sadiq Abdulla
- Department of Anesthesia, University of British Columbia and BC Women's Hospital, Vancouver, Canada
| | - Aggrey Lubikire
- Department of Anesthesia, Makerere University College of Health Sciences, Mulago, Uganda
| | - Mary T Nabukenya
- Department of Anesthesia, Makerere University College of Health Sciences, Mulago, Uganda
| | - Elizabeth Igaga
- Department of Anesthesia, Makerere University College of Health Sciences, Mulago, Uganda
| | - Fred Bulamba
- Department of Anesthesia, Busitema University Faculty of Health Sciences, Mbale, Uganda
| | - Daniel Semakula
- Innovations and Knowledge Translation Office, Makerere University College of Health Sciences, Mulago, Uganda
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Machado FC, Palmeira CCDA, Torres JNL, Vieira JE, Ashmawi HA. Intraoperative use of methadone improves control of postoperative pain in morbidly obese patients: a randomized controlled study. J Pain Res 2018; 11:2123-2129. [PMID: 30323647 PMCID: PMC6174683 DOI: 10.2147/jpr.s172235] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objectives Surgical patients still commonly experience postoperative pain. With the increasing prevalence of obesity, there is a growing demand for surgical procedures by this population. Intraoperative use of methadone has not been well assessed in this population. Materials and methods Patients with a body mass index of 35 kg/m2 or more undergoing bariatric surgery were randomly assigned to receive either fentanyl (group F) or methadone (group M) in anesthesia induction and maintenance. The primary outcome was morphine consumption during the first 24 hours after surgery through a patient-controlled analgesia device. Secondary outcomes were pain scores at rest and while coughing, opioid related side effects, and patient satisfaction. The patients were also evaluated 3 months after surgery for the presence of pain, dysesthesia, or paresthesia at surgical site. Results Postoperative morphine consumption was significantly higher for patients receiving fentanyl than methadone during the postoperative period at 2 hours (mean difference [MD] 6.4 mg; 95% CI 3.1-9.6; P<0.001), 2-6 hours (MD 11.4 mg; 95% CI 6.5-16.2; P<0.001), 6-24 hours (MD 10.4 mg; 95% CI 5.0-15.7; P<0.001), and 24-48 hours (MD 14.5 mg; 95% CI 3.9-25.1; P=0.01). Patients from group F had higher pain scores until 24 hours postoperatively, higher incidence of nausea and vomiting, lower satisfaction, and more evoked pain at surgical scar at the 3-month postoperative evaluation than group M. Conclusion Intraoperative methadone can safely lower postoperative opioid consumption and improve postoperative pain scores compared with fentanyl in morbidly obese patients.
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Affiliation(s)
| | | | | | - Joaquim Edson Vieira
- Anesthesiology Department, hcFMUsP, Universidade de São Paulo, São Paulo, Brazil,
| | - Hazem Adel Ashmawi
- Anesthesiology Department, hcFMUsP, Universidade de São Paulo, São Paulo, Brazil,
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Soft Tissue Mobilization Techniques Are Effective in Treating Chronic Pain Following Cesarean Section: A Multicenter Randomized Clinical Trial. ACTA ACUST UNITED AC 2018. [DOI: 10.1097/jwh.0000000000000103] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Ozturk Inal Z, Gorkem U, Inal HA. Effects of preoperative anxiety on postcesarean delivery pain and analgesic consumption: general versus spinal anesthesia. J Matern Fetal Neonatal Med 2018; 33:191-197. [PMID: 29886798 DOI: 10.1080/14767058.2018.1487948] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Objective: The aim of this study was to determine the effects of preoperative anxiety on the postoperative pain and analgesic consumption in patients undergoing cesarean deliveries (CDs).Materials and methods: This observational cohort study included 160 women, with ages ranging from 18 to 40 years old and a 37-week minimum gestation, received general (Group 1, n = 80) or spinal (Group 2, n = 80) anesthesia during an elective CD. The State Anxiety Inventory (SAI), Trait Anxiety Inventory (TAI), and Somatosensory Amplification Scale (SSAS) were used to measure the prenatal anxiety. The postoperative pain intensity was evaluated using the Visual Analogue Scale (VAS), and the pain and analgesic requirements were recorded at the 1st, 6th, 12th, 18th, and 24th postoperative hours.Results: No statistically significant differences were found between the groups in the demographics, clinical characteristics, or laboratory parameters. In addition, there were no differences with regard to the mean SAI, TAI, and SSAS scores and the diclofenac and pethidine consumptions (p > .05). The 1st hour [4.15 ± 1.84 versus 3.28 ± 2.41, odds ratio (OR) = 0.832, 95% confidence interval (CI) = 0.725-0.956, p = .009], 6th hour (3.85 ± 2.02 versus 3.13 ± 1.51, OR = 0.793, 95% CI = 0.668-0.942, p = .008), and 12th hour (3.64 ± 2.11 versus 2.94 ± 2.03, OR = 0.851, 95% CI = 0.737-0.983, p = .028) VAS scores were lower in Group 2 than in Group 1. No correlations were noted between the SAI, TAI, and SSAS scores and the VAS.Conclusions: While the patients with preoperative SAI scores >45 and who underwent cesarean deliveries (CDs) with general anesthesia had higher pain intensity scores in the first 12 hours than those underwent CDs with the spinal anesthesia, no difference was observed between the groups in terms of the postoperative analgesic requirements. Evaluating the patient's anxiety state and psychiatric evaluation may be useful for decreasing the postoperative pain intensity. Further studies are needed to corroborate our findings.
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Affiliation(s)
- Zeynep Ozturk Inal
- Department of Reproductive Endocrinology, Konya Education and Research Hospital, Konya, Turkey
| | - Umit Gorkem
- Department of Reproductive Endocrinology, Hitit University Medical Faculty, Çorum, Turkey
| | - Hasan Ali Inal
- Department of Reproductive Endocrinology, Konya Education and Research Hospital, Konya, Turkey
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Wasserman JB, Copeland M, Upp M, Abraham K. Effect of soft tissue mobilization techniques on adhesion-related pain and function in the abdomen: A systematic review. J Bodyw Mov Ther 2018; 23:262-269. [PMID: 31103106 DOI: 10.1016/j.jbmt.2018.06.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 03/15/2018] [Accepted: 05/13/2018] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To systematically review the effects of soft tissue mobilization (STM) on both surgical and non-surgical abdominal adhesion-related symptoms. STUDY DESIGN Systematic Review. BACKGROUND It is known that abdominal adhesions can cause a variety of symptoms with one of the most common being abdominal pain. To date, there is no known systematic review that documents the effects of STM on adhesion-related abdominal symptoms. METHODS AND MEASURES A systematic review of literature was indexed in the following databases: PubMed, Cochrane, Google Scholar, OVID, and EBSCO. The quality of the studies was assessed using the MINORS scale. RESULTS Nine studies satisfied the eligibility criteria for this systematic review. The studies' population age ranged from 10.7 to 89.4 years. Four articles were nonrandomized and had scores ranging from 3 to 14 out of 16 total on the MINORS scale. Five articles were randomized controlled trials or comparative studies and scores ranged from 16 to 23 out of 24 total on the MINORS scale. There were five articles that used pain as an objective measure and all of them reported a decrease in pain after treatment. Two studies looked at quality of life and function and both saw objective improvements following abdominal adhesion treatment. Collectively, there were also improvements seen in scar mobility, infertility, posture, a reduction in medication, increased pressure tolerance and decreased postoperative ileus. CONCLUSION The results of this review indicate preliminary strong evidence for the benefits of STM on symptoms relating to acute post-surgical adhesions, preliminary moderate evidence for the benefits of STM on symptoms relating to chronic non-surgical related adhesions (fertility and SBO) and moderate evidence for the benefits of STM on symptoms relating to chronic post-surgical adhesions.
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Affiliation(s)
- Jennifer B Wasserman
- Franklin Pierce University, 670 N. Commercial St. Suite 301, Manchester, NH, USA; Rocky Mountain University of Health Professions, Provo, UT, USA.
| | | | - Molly Upp
- Bellin Hospital, Ashwaubenon, Wisconsin, USA
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Wang L, Wei C, Xiao F, Chang X, Zhang Y. Incidence and risk factors for chronic pain after elective caesarean delivery under spinal anaesthesia in a Chinese cohort: a prospective study. Int J Obstet Anesth 2018. [DOI: 10.1016/j.ijoa.2018.01.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Ray-Griffith SL, Wendel MP, Stowe ZN, Magann EF. Chronic pain during pregnancy: a review of the literature. Int J Womens Health 2018; 10:153-164. [PMID: 29692634 PMCID: PMC5901203 DOI: 10.2147/ijwh.s151845] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND AND PURPOSE The majority of the reviews and studies on chronic pain in pregnancy have primarily focused on the pharmacological and non-pharmacological treatment options. The purpose of our review was to identify evidence-based clinical research for the evaluation and management of preexisting chronic pain in pregnancy, chronic pain associated with pregnancy, and chronic pain in relation to mode of delivery. METHODS A literature search was undertaken using the search engines PubMed, CINAHL, EBSCOhost, and Web of Science. Search terms used included "chronic pain" AND "pregnant OR pregnancy" OR "pregnancy complications" from inception through August 2016. RESULTS The basis of this review was the 144 articles that met inclusion criteria for this review. Based on our review of the current literature, we recommend 7 guidelines for chronic pain management during and after pregnancy: 1) complete history and physical examination; 2) monitor patients for alcohol, nicotine, and substance use; 3) collaborate with patient to set treatment goals; 4) develop a management plan; 5) for opioids, use lowest effective dose; 6) formulate a pain management plan for labor and delivery; and 7) discuss reproductive health with women with chronic pain. CONCLUSION The management of chronic pain associated with pregnancy is understudied. Obstetrical providers primarily manage chronic pain during pregnancy. Some general guidelines are provided for those health care providers until more information is available.
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Affiliation(s)
- Shona L Ray-Griffith
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Michael P Wendel
- Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Zachary N Stowe
- Department of Psychiatry, University of Wisconsin-Madison, Madison, WI, USA
| | - Everett F Magann
- Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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Incidence and severity of chronic pain after caesarean section: A systematic review with meta-analysis. Eur J Anaesthesiol 2018; 33:853-865. [PMID: 27635953 DOI: 10.1097/eja.0000000000000535] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND The frequency of caesarean section has increased dramatically in recent decades. Despite this, robust data regarding the consequences of caesarean section in terms of developing chronic postsurgical pain (CPSP) are still lacking. OBJECTIVE This systematic review analysed the incidence and severity of CPSP in women 3 to less than 6, 6 to less than 12, and at least 12 months after caesarean section. DESIGN Systematic review of prospective and retrospective observational studies and randomised controlled trials with meta-analysis. DATA SOURCE We searched MEDLINE to May 2015. ELIGIBILITY CRITERIA We included all studies investigating the incidence and/or severity of CPSP at least 3 months after caesarean section. The primary outcome was chronic postsurgical wound pain (CPSP 'wound'). Secondary outcomes were persistent pain in the back area, pelvic region or reported as residual pain, and severity of 'birth-related' chronic pain. RESULTS Meta-analysis using the random-effects model based on 15 studies (n = 4475) reporting CPSP 'wound' at 3 to less than 6 months after caesarean section revealed an incidence of 15.4% [95% confidence interval (CI): 9.9 to 20.9%]. For 6 to less than 12 and at least 12 months after caesarean section, the incidence of CPSP 'wound' was estimated at 11.5% (95% CI: 8.1 to 15.0%, n = 3345) and 11.2% (95% CI: 7.4 to 15.0%, n = 3451), respectively. Meta-regression analysis using the publication year as predictor revealed stable CPSP 'wound' incidences at each postoperative time slot from 2002 to the present. Of those patients who reported chronic pain, 9.6% (95% CI: 0.0 to 21.0%) had severe pain, 23.5% (95% CI: 10.0 to 37.0%) had moderate pain and 49.2% (95% CI: 18.9 to 79.4%) had mild pain at 6 months. LIMITATIONS Major limitations are high statistical heterogeneity of the meta-analyses and inconsistencies in reporting severity of chronic 'birth-related' pain. CONCLUSION This meta-analysis finds a clinically relevant incidence of CPSP 'wound' after caesarean section ranging from 15% at 3 months to 11% at 12 months or longer that has been largely stable in recent years.
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Abstract
OBJECTIVE A clinically relevant number of patients report pain 1 year after vaginal delivery or Caesarean delivery. Study objectives were to identify the incidence of peripartum pain; determine whether pre-existing pain, pregnancy pain, or pain 2 weeks postpartum predicts pain at 3 months; and to identify whether delivery mode, epidural analgesia use, or delivery complications predict non-genito-pelvic pain postpartum. METHODS Primiparous women at 30 to 36 weeks GA with an uncomplicated singleton pregnancy were recruited from a large perinatal clinic. Participants completed questionnaires on sociodemographics and non-genito-pelvic pain. Questionnaires were completed in the perinatal clinic and then electronically 2 weeks and 3 months postpartum. RESULTS Of the 133 women included, 50 patients (38%) had a chronic pain condition or pain prior to pregnancy, whereas 73 patients (55%) reported pain in pregnancy. Pain was present 2 weeks postpartum in 57 patients (43%) and 3 months postpartum in 33 patients (25%). Patients with pre-existing pain were more likely to experience pain 2 weeks postpartum (P = 0.006), and patients with pain 2 weeks postpartum were more likely to have pain 3 months postpartum (P = 0.005). Women who had a Caesarean delivery (P < 0.001) were more likely to have non-genito-pelvic pain at 2 weeks but not 3 months postpartum. CONCLUSIONS Women with pain 2 weeks postpartum were significantly more likely to have pain at 3 months. Further investigation is required to determine whether pre-existing pain, pain in pregnancy, or pain at 2 weeks postpartum can adequately predict the likelihood of chronic pain.
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Wasserman JB, Steele-Thornborrow JL, Yuen JS, Halkiotis M, Riggins EM. Chronic caesarian section scar pain treated with fascial scar release techniques: A case series. J Bodyw Mov Ther 2016; 20:906-913. [DOI: 10.1016/j.jbmt.2016.02.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 02/10/2016] [Accepted: 02/15/2016] [Indexed: 11/26/2022]
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A Clinical Experimental Model to Evaluate Analgesic Effect of Remote Ischemic Preconditioning in Acute Postoperative Pain. PAIN RESEARCH AND TREATMENT 2016; 2016:5093870. [PMID: 27446611 PMCID: PMC4944064 DOI: 10.1155/2016/5093870] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Accepted: 06/07/2016] [Indexed: 11/18/2022]
Abstract
This study aims to evaluate the viability of a clinical model of remote ischemic preconditioning (RIPC) and its analgesic effects. It is a prospective study with twenty (20) patients randomly divided into two groups: control group and RIPC group. The opioid analgesics consumption in the postoperative period, the presence of secondary mechanical hyperalgesia, the scores of postoperative pain by visual analog scale, and the plasma levels interleukins (IL-6) were evaluated. The tourniquet applying after spinal anesthetic block was safe, producing no pain for all patients in the tourniquet group. The total dose of morphine consumption in 24 hours was significantly lower in RIPC group than in the control group (p = 0.0156). The intensity analysis of rest pain, pain during coughing and pain in deep breathing, showed that visual analogue scale (VAS) scores were significantly lower in RIPC group compared to the control group: p = 0.0087, 0.0119, and 0.0015, respectively. There were no differences between groups in the analysis of presence or absence of mechanical hyperalgesia (p = 0.0704) and in the serum levels of IL-6 dosage over time (p < 0.0001). This clinical model of remote ischemic preconditioning promoted satisfactory analgesia in patients undergoing conventional cholecystectomy, without changing serum levels of IL-6.
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