Comparison of Postoperative Pain Severity Between Primary and Repeated Cesarean Section: a Prospective Cohort Study

Overview

Journal BMC Anesthesiol

Publisher Biomed Central

Specialty Anesthesiology

Date 2025 Feb 22

PMID 39987048

Authors

Zemedkun Getahun

Mebratu Kebede

Mebratu Tilla

Gedion Asnak

Margherita Iuzzolino

Alemu Urmale

Hailemariam Getachew

Abebayehu Zemedkun

Tsegaye Demeke

Milion Abdi

Ashagire Sintayehu

Getahun Dendir

Affiliations

Soon will be listed here.

Abstract

Background: The cesarean section was associated with moderate to severe postoperative pain. Uncertain differences exist between parturient who undergo a primary cesarean section and a repeat cesarean section in terms of post-operative pain.

Objective: To compare the degree of postoperative pain in patients who had primary and repeat cesarean sections.

Method: An institutional-based prospective cohort study was conducted on 336 patients who fulfilled eligibility criteria and underwent caesarian section under spinal anesthesia. Study participants were selected by a systematic random sampling technique. An independent sample t test and a Mann-Whitney U test were used to compare symmetric and asymmetric data, respectively. Time to first analgesic request was analyzed using log rank Kaplan-Meier survival curves and cox-regression for covariates. Comparisons of categorical variables between groups were done using the chi-square test. The significance was determined at a P value of < 0.05.

Results: There was a high Risk of moderate to severe postoperative pain in repeated caesarean section compared to primary caesarean section in both incisional pain (RR, 1.364[95% CI, 1.12-1.66], p = 0.002) and visceral pain (RR, 1.66[95% CI, 1.40-1.66], p = 0.001). In comparison to the primiparas, parturient with repeated cesarean sections had highest post-operative pain severity in NRS with median NRS of 5(IQR, 3-5) at the 4th hour (p < 0.001) for the incisional pain and 6(IQR, 5-7) at the 8th hour for visceral pain, respectively, for the repeated group. The primiparas group had a longer median time to first rescue analgesic administration (median [minute], 875.7[95% CI, 750.3-1001]; P < 0.001)) than the repeated group (median [minute], 534.8 [95% CI, 426.8-642.8]; P < 0.001.

Conclusions: Compared to primary CS, repeated cesarean had a high incidence of moderate to severe postoperative pain, both visceral and incisional; within 48-h. In future endeavors of crafting postoperative analgesic plans, it is imperative to take into account individual variations and distinctions.

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