Frequency of Pain Intensity and Factors Affecting it after Cesarean Section Using Spinal Anesthesia
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Abstract
Background: Postoperative pain is an important public health issue that affects the sensory and emotional experiences of patients. This study aimed to understand the impact of pain management on patients.
Methods: The present study was a retrospective cross-sectional study conducted on women over 18 years of age who underwent cesarean section with spinal anesthesia in Shahid Beheshti Hospital of Isfahan.
Results: In this study, 250 women with a Mean age of 31.75 years and a Mean pain intensity of 8.15 participated. Postoperative pain was more common in people without underlying disease and obese people had more pain. Intravenous pain relievers such as pethidine and diclofenac suppositories temporarily reduced the pain intensity.
Conclusion: This study showed that the pain after cesarean section was significantly influenced by the length of the operation, the type of anesthesia, and painkillers, which require strategies to reduce the pain.
[1] Demelash G, Berhe YW, Gebregzi AH, Chekol WB. Prevalence and factors associated with postoperative pain after cesarean section at a comprehensive specialized hospital in Northwest Ethiopia: prospective observational study. Open Access Surg. 2022; 15:1.
[2] Admassu WS, Hailekiros AG, Abdissa ZD. Severity and risk factors of post-operative pain in University of Gondar Hospital, Northeast Ethiopia. J Anesth Clin Res. 2016; 7(10):675.
[3] Hussen I, Worku M, Geleta D, Mahamed AA, Abebe M, Molla W, et al. Post-operative pain and associated factors after cesarean section at Hawassa University Comprehensive Specialized Hospital, Hawassa, Ethiopia: A cross-sectional study. Ann Med Surg. 2022; 81:1.
[4] Mehdiratta JE, Saab R, Chen Z, Li YJ, Habib AS. Patient and procedural risk factors for increased postoperative pain after cesarean delivery under neuraxial anesthesia: a retrospective study. Int J Obstet Anesth. 2020; 44:60-7.
[5] Nazemroaya B, Keleidari B, Arabzadeh A, Honarmand A. Comparison of Intraperitoneal Versus Intravenous Dexamethasone on Postoperative Pain, Nausea, and Vomiting After Laparoscopic Cholecystectomy. Anesth Pain Med. 2022; 12(2):e122203. Published 2022 Apr 30.
[6] Borges NC, de Deus JM, Guimarães RA, Conde DM, Bachion MM, de Moura LA, et al. 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(9):e0238634.
[7] Gan TJ. Poorly controlled postoperative pain: prevalence, consequences, and prevention. J Pain Res. 2017; 10:2287.
[8] Komatsu R, Ando K, Flood PD. Factors associated with persistent pain after childbirth: a narrative review. Br J Anaesth. 2020; 124(3):e117-30.
[9] Duan G, Yang G, Peng J, Duan Z, Li J, Tang X, et al. Comparison of postoperative pain between patients who underwent primary and repeated cesarean section: a prospective cohort study. BMC Anesthesiol. 2019; 19(1):1-12.
[10] Richebé P, Capdevila X, Rivat C. Persistent Post-surgical Pain: Pathophysiology and Preventative Pharmacologic Considerations. Anesthesiology. 2018; 129:590–607.
[11] Chapman CR, Vierck CJ. The Transition of Acute Postoperative Pain to Chronic Pain: An Integrative Overview of Research on Mechanisms. J Pain. 2017; 18:359.e1-359.e38.
[12] Ghosouri A, Jabalameli M, Nazemroaya B, Najafian R. Effect of intravenous administration of atropine-neostigmine versus ondansetron in prevention postdural puncture headache in cesarean section under spinal: a randomized clinical trial. Tehran Univ Med J. 2023; 81(7):503-513.
[13] Schwenkglenks M, Gerbershagen HJ, Taylor RS, Pogatzki-Zahn E, Komann M, Rothaug J, et al. Correlates of satisfaction with pain treatment in the acute postoperative period: results from the international PAIN OUT registry. PAIN®. 2014; 155(7):1401-1411.
[14] Baca Q, Marti F, Poblete B, Gaudilliere B, Aghaeepour N, Angst MS. Predicting acute pain after surgery: A multivariate analysis. Ann Surg. 2021; 273(2):289.
[15] Manjiani D PD, Kunnumpurath S, Kaye AD, Vadivelu N. Availability and utilization of opioids for pain management: global issues. Ochsner J. 2014; 14:1-10.
[16] Powell RA RL, Mwangi-Powell FN, Cleary J, Cherny N. Failing to numb the pain: the untreated epidemic. S Afr Med J. 2014; 104(2):117-118.
[17] Selman L, Simms V, Penfold S, Powell RA, Mwangi-Powell F, Downing J,, et al. My dreams are shuttered down and it hurts lots’-a qualitative study of palliative care needs and their management by HIV outpatient services in Kenya and Uganda. BMC Palliat Care. 2013; 12:35.
[18] Dekker A AJ, Le Roux K, Gaunt B. “What is killing me most”: chronic pain and the need for palliative care in the Eastern Cape, South Africa. J Pain Palliat Care Pharmacother. 2012; 26:334-340.
[19] Sangkum L, Thamjamrassri T, Arnuntasupakul V, Chalacheewa T. The Current Consideration, Approach, and Management in Postcesarean Delivery Pain Control: A Narrative Review. Anesthesiology Res Pract. 2021; 2021:1-10.
[20] Buhagiar L, Cassar OA, Brincat MP, Buttigieg GG, Inglott AS, Adami MZ, et al. Predictors of post-caesarean section pain and analgesic consumption. J Anaesthesiol Clin Pharmacol. 2011; 27(2):185-190.
[21] Eslamizade N, Saeedikia S, Beiranvand S, Noparast M. The effects of religion and spirituality on postoperative pain, hemodynamic functioning, and anxiety after cesarean section. Acta Med Iran. 2014; 52:909-15.
[22] Yang MM, Hartley RL, Leung AA, Ronksley PE, Jetté N, Casha S, et al. Preoperative predictors of poor acute postoperative pain control: a systematic review and meta-analysis. BMJ Open. 2019; 9(4):e025091.
[23] Eshete MT, Baeumler PI, Siebeck M, Tesfaye M, Haileamlak A, Michael GG, et al. Quality of postoperative pain management in Ethiopia: a prospective longitudinal study. PLoS One. 2019; 14(5):e0215563.
[24] Liu SS, Buvanendran A, Rathmell JP, Sawhney M, Bae JJ, Moric M, et al. Predictors for moderate to severe acute postoperative pain after total hip and knee replacement. Int Orthop. 2012; 36(11):2261-7.
[25] Wang LZ, Wei CN, Xiao F, Chang XY, Zhang YF. 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; 34:21–27.
[26] Gamez BH, Habib AS. Predicting severity of acute pain after cesarean delivery: a narrative review. Anesth Analg. 2018; 126(5):1606–1614.
[27] Pereira TRC, Souza FGD, Beleza ACS. Implications of pain in functional activities in the immediate postpartum period according to the mode of delivery and parity: an observational study. Braz J Phys Ther. 2017; 21(1):37–43.
[28] Cançado TO, Omais M, Ashmawi HA, Torres ML. Chronic pain after cesarean section: influence of anesthetic/surgical technique and postoperative analgesia. Rev Bras Anestesiol. 2012; 62:768–774.
[29] Misal US, Joshi SA, Shaikh MM. Delayed recovery from anesthesia: a postgraduate educational review. Anesth Essays Res. 2016; 10(2):164.
[30] Borges NC, e Silva BC, Pedroso CF, Silva TC, Tatagiba BS, Pereira LV. Postoperative pain in women undergoing caesarean section. Enfermería Glob. 2017; 16(4):374-383.
[31] Demelash G, Woldegerima Y, Hailekiros A, Birlie W. Postoperative pain after cesarean section at University of Gondar Comprehensive Specialized Hospital, Gondar, Northwest Ethiopia: A cross-sectional follow-up study. 2020.
[32] Woldehaimanot TE, Eshetie TC, Kerie MW. Postoperative pain management among surgically treated patients in an Ethiopian hospital. PLoS One. 2014; 9(7):e102835.
[33] Kintu A, Abdulla S, Lubikire A, Nabukenya MT, Igaga E, Bulamba F, et al. Postoperative pain after cesarean section: assessment and management in a tertiary hospital in a low-income country. BMC Health Serv Res. 2019; 19(1):1-6.
[34] Borges ND, Pereira LV, Moura LA, Silva TC, Pedroso CF. Predictors for moderate to severe acute postoperative pain after cesarean section. Pain Res Manag. 2016; 2016:1-6.
[35] Murray AA, Retief FW. Acute postoperative pain in 1231 patients at a developing country referral hospital: incidence and risk factors. S Afr J Anaesth Analg. 2016; 22(1):26-31.
[36] Karlström A, Engström‐Olofsson R, Norbergh KG, Sjöling M, Hildingsson I. Postoperative pain after cesarean birth affects breastfeeding and infant care. J Obstet Gynecol Neonatal Nurs. 2007; 36(5):430-440.
[37] Chan JJI, Thong SY, Tan MGE. Factors affecting postoperative pain and delay in discharge from the post-anesthesia care unit: a descriptive correlational study. Proc Singapore Healthc. 2018; 27(2):118-124.
[38] Samah Mohsen RN, Mokayad S, Ouda M, Al-Sheikh M. Post-operative pain after caesarean delivery: initial assessment for quality improvement. Int J Caring Sci. 2018; 11(1):136-144.
[39] Lo LW, Suh J, Chen JY, Liow MH, Allen JC, Lo NN, et al. Early postoperative pain after total knee arthroplasty is associated with subsequent poorer functional outcomes and lower satisfaction. J Arthroplasty. 2021; 36(7):2466-2472.
[40] Tiruneh A, Tamire T, Kibret S. The magnitude and associated factors of post-operative pain at Debre Tabor Comprehensive Specialized Hospital, Debre Tabor, Ethiopia, 2018. SAGE Open Med. 2021; 9:20503121211014730.
[41] Larsson C, Djuvfelt E, Lindam A, Tunón K, Nordin P. Surgical complications after cesarean section: A population-based cohort study. PLoS One. 2021; 16(10):e0258222.
[42] Foldspang A, Hvidman L, Mommsen S, Nielsen JB. Risk of postpartum urinary incontinence associated with pregnancy and mode of delivery. Acta Obstet Gynecol Scand. 2004; 83(10):923–7.
[43] Fogelberg M, Baranov A, Herbst A, Vikhareva O. Underreporting of complete uterine rupture and uterine dehiscence in women with previous cesarean section. J Matern Fetal Neonatal Med. 2017; 30(17):2058–61.
[44] Larsson C, Hedberg CL, Lundgren E, Soderstrom L, Tunón K, Nordin P. Anal incontinence after caesarean and vaginal delivery in Sweden: a national population-based study. Lancet. 2019; 393(10177):1233–9.
[45] Jin J, Peng L, Chen Q, Zhang D, Ren L, Qin P, et al. Prevalence and risk factors for chronic pain following cesarean section: a prospective study. BMC Anesthesiol. 2016; 16(1):99.
[46] Akhavanakbari G, Entezariasl M, Isazadehfar K, Kahnamoyiagdam F. The effects of indomethacin, diclofenac, and acetaminophen suppository on pain and opioid consumption after cesarean section. Perspect Clin Res. 2013; 4(2):136-141.
[2] Admassu WS, Hailekiros AG, Abdissa ZD. Severity and risk factors of post-operative pain in University of Gondar Hospital, Northeast Ethiopia. J Anesth Clin Res. 2016; 7(10):675.
[3] Hussen I, Worku M, Geleta D, Mahamed AA, Abebe M, Molla W, et al. Post-operative pain and associated factors after cesarean section at Hawassa University Comprehensive Specialized Hospital, Hawassa, Ethiopia: A cross-sectional study. Ann Med Surg. 2022; 81:1.
[4] Mehdiratta JE, Saab R, Chen Z, Li YJ, Habib AS. Patient and procedural risk factors for increased postoperative pain after cesarean delivery under neuraxial anesthesia: a retrospective study. Int J Obstet Anesth. 2020; 44:60-7.
[5] Nazemroaya B, Keleidari B, Arabzadeh A, Honarmand A. Comparison of Intraperitoneal Versus Intravenous Dexamethasone on Postoperative Pain, Nausea, and Vomiting After Laparoscopic Cholecystectomy. Anesth Pain Med. 2022; 12(2):e122203. Published 2022 Apr 30.
[6] Borges NC, de Deus JM, Guimarães RA, Conde DM, Bachion MM, de Moura LA, et al. 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(9):e0238634.
[7] Gan TJ. Poorly controlled postoperative pain: prevalence, consequences, and prevention. J Pain Res. 2017; 10:2287.
[8] Komatsu R, Ando K, Flood PD. Factors associated with persistent pain after childbirth: a narrative review. Br J Anaesth. 2020; 124(3):e117-30.
[9] Duan G, Yang G, Peng J, Duan Z, Li J, Tang X, et al. Comparison of postoperative pain between patients who underwent primary and repeated cesarean section: a prospective cohort study. BMC Anesthesiol. 2019; 19(1):1-12.
[10] Richebé P, Capdevila X, Rivat C. Persistent Post-surgical Pain: Pathophysiology and Preventative Pharmacologic Considerations. Anesthesiology. 2018; 129:590–607.
[11] Chapman CR, Vierck CJ. The Transition of Acute Postoperative Pain to Chronic Pain: An Integrative Overview of Research on Mechanisms. J Pain. 2017; 18:359.e1-359.e38.
[12] Ghosouri A, Jabalameli M, Nazemroaya B, Najafian R. Effect of intravenous administration of atropine-neostigmine versus ondansetron in prevention postdural puncture headache in cesarean section under spinal: a randomized clinical trial. Tehran Univ Med J. 2023; 81(7):503-513.
[13] Schwenkglenks M, Gerbershagen HJ, Taylor RS, Pogatzki-Zahn E, Komann M, Rothaug J, et al. Correlates of satisfaction with pain treatment in the acute postoperative period: results from the international PAIN OUT registry. PAIN®. 2014; 155(7):1401-1411.
[14] Baca Q, Marti F, Poblete B, Gaudilliere B, Aghaeepour N, Angst MS. Predicting acute pain after surgery: A multivariate analysis. Ann Surg. 2021; 273(2):289.
[15] Manjiani D PD, Kunnumpurath S, Kaye AD, Vadivelu N. Availability and utilization of opioids for pain management: global issues. Ochsner J. 2014; 14:1-10.
[16] Powell RA RL, Mwangi-Powell FN, Cleary J, Cherny N. Failing to numb the pain: the untreated epidemic. S Afr Med J. 2014; 104(2):117-118.
[17] Selman L, Simms V, Penfold S, Powell RA, Mwangi-Powell F, Downing J,, et al. My dreams are shuttered down and it hurts lots’-a qualitative study of palliative care needs and their management by HIV outpatient services in Kenya and Uganda. BMC Palliat Care. 2013; 12:35.
[18] Dekker A AJ, Le Roux K, Gaunt B. “What is killing me most”: chronic pain and the need for palliative care in the Eastern Cape, South Africa. J Pain Palliat Care Pharmacother. 2012; 26:334-340.
[19] Sangkum L, Thamjamrassri T, Arnuntasupakul V, Chalacheewa T. The Current Consideration, Approach, and Management in Postcesarean Delivery Pain Control: A Narrative Review. Anesthesiology Res Pract. 2021; 2021:1-10.
[20] Buhagiar L, Cassar OA, Brincat MP, Buttigieg GG, Inglott AS, Adami MZ, et al. Predictors of post-caesarean section pain and analgesic consumption. J Anaesthesiol Clin Pharmacol. 2011; 27(2):185-190.
[21] Eslamizade N, Saeedikia S, Beiranvand S, Noparast M. The effects of religion and spirituality on postoperative pain, hemodynamic functioning, and anxiety after cesarean section. Acta Med Iran. 2014; 52:909-15.
[22] Yang MM, Hartley RL, Leung AA, Ronksley PE, Jetté N, Casha S, et al. Preoperative predictors of poor acute postoperative pain control: a systematic review and meta-analysis. BMJ Open. 2019; 9(4):e025091.
[23] Eshete MT, Baeumler PI, Siebeck M, Tesfaye M, Haileamlak A, Michael GG, et al. Quality of postoperative pain management in Ethiopia: a prospective longitudinal study. PLoS One. 2019; 14(5):e0215563.
[24] Liu SS, Buvanendran A, Rathmell JP, Sawhney M, Bae JJ, Moric M, et al. Predictors for moderate to severe acute postoperative pain after total hip and knee replacement. Int Orthop. 2012; 36(11):2261-7.
[25] Wang LZ, Wei CN, Xiao F, Chang XY, Zhang YF. 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; 34:21–27.
[26] Gamez BH, Habib AS. Predicting severity of acute pain after cesarean delivery: a narrative review. Anesth Analg. 2018; 126(5):1606–1614.
[27] Pereira TRC, Souza FGD, Beleza ACS. Implications of pain in functional activities in the immediate postpartum period according to the mode of delivery and parity: an observational study. Braz J Phys Ther. 2017; 21(1):37–43.
[28] Cançado TO, Omais M, Ashmawi HA, Torres ML. Chronic pain after cesarean section: influence of anesthetic/surgical technique and postoperative analgesia. Rev Bras Anestesiol. 2012; 62:768–774.
[29] Misal US, Joshi SA, Shaikh MM. Delayed recovery from anesthesia: a postgraduate educational review. Anesth Essays Res. 2016; 10(2):164.
[30] Borges NC, e Silva BC, Pedroso CF, Silva TC, Tatagiba BS, Pereira LV. Postoperative pain in women undergoing caesarean section. Enfermería Glob. 2017; 16(4):374-383.
[31] Demelash G, Woldegerima Y, Hailekiros A, Birlie W. Postoperative pain after cesarean section at University of Gondar Comprehensive Specialized Hospital, Gondar, Northwest Ethiopia: A cross-sectional follow-up study. 2020.
[32] Woldehaimanot TE, Eshetie TC, Kerie MW. Postoperative pain management among surgically treated patients in an Ethiopian hospital. PLoS One. 2014; 9(7):e102835.
[33] Kintu A, Abdulla S, Lubikire A, Nabukenya MT, Igaga E, Bulamba F, et al. Postoperative pain after cesarean section: assessment and management in a tertiary hospital in a low-income country. BMC Health Serv Res. 2019; 19(1):1-6.
[34] Borges ND, Pereira LV, Moura LA, Silva TC, Pedroso CF. Predictors for moderate to severe acute postoperative pain after cesarean section. Pain Res Manag. 2016; 2016:1-6.
[35] Murray AA, Retief FW. Acute postoperative pain in 1231 patients at a developing country referral hospital: incidence and risk factors. S Afr J Anaesth Analg. 2016; 22(1):26-31.
[36] Karlström A, Engström‐Olofsson R, Norbergh KG, Sjöling M, Hildingsson I. Postoperative pain after cesarean birth affects breastfeeding and infant care. J Obstet Gynecol Neonatal Nurs. 2007; 36(5):430-440.
[37] Chan JJI, Thong SY, Tan MGE. Factors affecting postoperative pain and delay in discharge from the post-anesthesia care unit: a descriptive correlational study. Proc Singapore Healthc. 2018; 27(2):118-124.
[38] Samah Mohsen RN, Mokayad S, Ouda M, Al-Sheikh M. Post-operative pain after caesarean delivery: initial assessment for quality improvement. Int J Caring Sci. 2018; 11(1):136-144.
[39] Lo LW, Suh J, Chen JY, Liow MH, Allen JC, Lo NN, et al. Early postoperative pain after total knee arthroplasty is associated with subsequent poorer functional outcomes and lower satisfaction. J Arthroplasty. 2021; 36(7):2466-2472.
[40] Tiruneh A, Tamire T, Kibret S. The magnitude and associated factors of post-operative pain at Debre Tabor Comprehensive Specialized Hospital, Debre Tabor, Ethiopia, 2018. SAGE Open Med. 2021; 9:20503121211014730.
[41] Larsson C, Djuvfelt E, Lindam A, Tunón K, Nordin P. Surgical complications after cesarean section: A population-based cohort study. PLoS One. 2021; 16(10):e0258222.
[42] Foldspang A, Hvidman L, Mommsen S, Nielsen JB. Risk of postpartum urinary incontinence associated with pregnancy and mode of delivery. Acta Obstet Gynecol Scand. 2004; 83(10):923–7.
[43] Fogelberg M, Baranov A, Herbst A, Vikhareva O. Underreporting of complete uterine rupture and uterine dehiscence in women with previous cesarean section. J Matern Fetal Neonatal Med. 2017; 30(17):2058–61.
[44] Larsson C, Hedberg CL, Lundgren E, Soderstrom L, Tunón K, Nordin P. Anal incontinence after caesarean and vaginal delivery in Sweden: a national population-based study. Lancet. 2019; 393(10177):1233–9.
[45] Jin J, Peng L, Chen Q, Zhang D, Ren L, Qin P, et al. Prevalence and risk factors for chronic pain following cesarean section: a prospective study. BMC Anesthesiol. 2016; 16(1):99.
[46] Akhavanakbari G, Entezariasl M, Isazadehfar K, Kahnamoyiagdam F. The effects of indomethacin, diclofenac, and acetaminophen suppository on pain and opioid consumption after cesarean section. Perspect Clin Res. 2013; 4(2):136-141.
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How to Cite
1.
Hoghooghy A, Ghosouri A, Honarmand A, Masaeli M, Ahmadinia F. Frequency of Pain Intensity and Factors Affecting it after Cesarean Section Using Spinal Anesthesia. Arch Anesth & Crit Care. 2025;.
