Comparison of Predicted and Perceived Pain from Epidural and Spinal Puncture in Patients Undergoing Elective Caesarean Section

Abstract

The intensity of pain expected by patients before an epidural and/or a spinal puncture is uncertain. The main purpose of this study was to identify and compare the intensity of pain predicted and perceived by patients having an epidural and a spinal procedure. After screening for relevant exclusion criteria, 50 women who were undergoing elective caesarean section under combined spinal-epidural anaesthesia (double-segment technique) were enrolled in the study. Infiltration anaesthesia prior to needle insertion was performed for the epidural but not the spinal puncture. Pain assessments, using a 100 mm visual analogue pain scale, were made before (predicted pain) and after (perceived pain) the epidural and the spinal puncture. Predicted pain for epidural and spinal insertion (epidural 60.6±20.5 mm, spinal: 55.1±24 mm) was significantly higher than the pain perceived (epidural 36.3±20 mm, spinal 46.1±23.2 mm) (epidural P <0.001, spinal P=0.031). Patients who were scheduled for an elective caesarean section under combined spinal-epidural anaesthesia predicted 1.2-to 1.7-fold stronger pain intensity than they perceived during the procedure. Patients should be informed that a regional anaesthetic, especially epidural, procedure is often less painful than the patient's expectation.

Procedural Aspects of Epidural Catheter Placement: A Prospective Observational Study of 173 Epidural Catheter Insertions

“…We also found that patients expected the procedure to be significantly more painful than they subsequently experienced. This is consistent with the findings of previous smaller studies of epidural and spinal anesthesia procedures 5,7,8 .…”

“…When categorized into pain groups 3,4 , actual pain associated with the procedure was reported as no/mild pain in most patients (58%), moderate pain in 38% of the patients, and severe pain in only 4% of the patients. We showed that the use of procedural medication in our study had only a minor influence on experienced pain, and the observed levels were comparable to those observed for the EDC procedure [5][6][7] . We also found that patients expected the procedure to be significantly more painful than they subsequently experienced.…”

“…Second, we did not use a standardized script for obtaining preprocedural patient information but relied on anesthetists' information, as described in our department's standard operating procedure. Since both patients' a priori expectations and physicians' wording about the impending procedure may influence experienced procedural pain, this approach may introduce some potential bias 7,22 . Third, we did not use a validated questionnaire to examine postoperative side effects since no such questionnaire exists.…”

Anticipated vs. Experienced Pain at Site of Spinal Needle Insertion in Patients Undergoing Elective Lower Segment Caesarean Section: Perspective from Resource-Limited Region

“…Terefore, we measured the anticipated pain of the whole procedure of the spinal block, i.e., from the position and local infltration until the application of the block. Tis is in contrast to T. Yano et al who did not apply local anaesthetic infltration for the spinal block and measured only spinal needle pain [11]. However, Mogensen et al applied local anaesthetic infltration before 18 G Tuohy needle insertion and measured pain due to an epidural catheter [12].…”

“…Studies have shown that the patient's expectation of pain is higher than what they experience in real. Yano et al studied predicted and perceived pain in females undergoing elective CS and found overestimated anticipated pain by patients [ 11 ]. Mogensen et al also found higher expected pain in the epidural procedure [ 12 ].…”