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

Publication ,  Journal Article
Mehdiratta, JE; Saab, R; Chen, Z; Li, Y-J; Habib, AS
Published in: Int J Obstet Anesth
November 2020

BACKGROUND: There is significant interindividual variability in pain experienced after cesarean delivery. The goal of this study was to identify risk factors for increased postoperative pain in women undergoing cesarean delivery under neuraxial anesthesia with neuraxial morphine. METHODS: A retrospective chart review was conducted (June 1, 2013 to August 25, 2015). Patients were categorized into three groups, according to the weighted area-under-the-curve (AUC) of pain scores within 48 h of surgery, as mild (weighted AUC 0-3), moderate (4-6) or severe (7-10) pain. We evaluated potential factors that could influence variability in pain, including patient demographics, comorbidities, obstetric history, and surgical details. RESULTS: A total of 1899 patients were included in the analysis. Pain was mild in 896 patients, moderate in 895, and severe in 108 patients. In the multivariable analysis, the following factors were associated with increased pain severity: history of chronic pain (OR 4.12, 95% CI 1.15 to 14.75]), current tobacco use (2.52, 1.17 to 5.44), pre-existing anxiety (1.93, 1.21 to 3.07), receipt of intra-operative intravenous ketamine or fentanyl (1.56, 1.21 to 2.01), and repeat cesarean delivery (1.54, 1.18 to 2.02). Being of non-Black race and having private health insurance were associated with lower pain severity (OR 0.44, 95% CI 0.31 to 0.62 and 0.51, 0.39 to 0.68, respectively). The overall accuracy of the model was 56%. CONCLUSIONS: Certain patient and procedural factors were associated with higher levels of reported postoperative pain. Patients with those factors may require a more targeted analgesic strategy for post-cesarean delivery pain control.

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Published In

Int J Obstet Anesth

DOI

EISSN

1532-3374

Publication Date

November 2020

Volume

44

Start / End Page

60 / 67

Location

Netherlands

Related Subject Headings

  • Smoking
  • Severity of Illness Index
  • Risk Factors
  • Retrospective Studies
  • Racial Groups
  • Pregnancy
  • Pain, Postoperative
  • Humans
  • Female
  • Chronic Pain
 

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Mehdiratta, J. E., Saab, R., Chen, Z., Li, Y.-J., & Habib, A. S. (2020). Patient and procedural risk factors for increased postoperative pain after cesarean delivery under neuraxial anesthesia: a retrospective study. Int J Obstet Anesth, 44, 60–67. https://doi.org/10.1016/j.ijoa.2020.07.006
Mehdiratta, J. E., R. Saab, Z. Chen, Y. -. J. Li, and A. S. Habib. “Patient and procedural risk factors for increased postoperative pain after cesarean delivery under neuraxial anesthesia: a retrospective study.Int J Obstet Anesth 44 (November 2020): 60–67. https://doi.org/10.1016/j.ijoa.2020.07.006.
Mehdiratta, J. E., et al. “Patient and procedural risk factors for increased postoperative pain after cesarean delivery under neuraxial anesthesia: a retrospective study.Int J Obstet Anesth, vol. 44, Nov. 2020, pp. 60–67. Pubmed, doi:10.1016/j.ijoa.2020.07.006.
Journal cover image

Published In

Int J Obstet Anesth

DOI

EISSN

1532-3374

Publication Date

November 2020

Volume

44

Start / End Page

60 / 67

Location

Netherlands

Related Subject Headings

  • Smoking
  • Severity of Illness Index
  • Risk Factors
  • Retrospective Studies
  • Racial Groups
  • Pregnancy
  • Pain, Postoperative
  • Humans
  • Female
  • Chronic Pain