Predictors for Moderate to Severe Acute Postoperative Pain after Cesarean Section

Abstract

Background. Moderate to severe postoperative pain affects performance of daily activities and it contributes to persistent postoperative pain. In patients submitted to cesarean section, this pain can also interfere with women's ability to care for their babies, to effectively breastfeed, and to satisfactorily interact with their children. Factors influencing the pain perception during the immediate postoperative period have not been widely pursued. Objective. To investigate the incidence and predicting factors of postoperative pain after cesarean section. Methods. A prospective longitudinal study with 1,062 women submitted to cesarean section. We collected sociodemographic, clinical, surgical, and health behavior data. We used the 11-point Numerical Pain and the Hospital Anxiety and Depression Scales. We performed logistic analysis to identify predictors of moderate to severe postoperative pain. Results. The incidence of moderate-severe postoperative pain was 78.4% (CI: 95%: 75.9%–80.8%). The preoperative anxiety (OR = 1.60; CI 95%: 1.22–2.30) and intrathecal morphine with fentanyl (OR = 0,23; CI 95%: 0.08–0.66) were significantly associated with moderate-severe postoperative pain report. Conclusion. The preoperative anxiety increases the risk of moderate-severe postoperative pain in women submitted to cesarean section. The intrathecal morphine with fentanyl added to bupivacaine was a protective factor against this pain.

Relationship of Anxiety and Preoperative Depression With Post-Operative Pain

“…2 The proportion of patients classified as having anxiety and depression using HADS was similar to that found in a study of 1062 women who underwent cesarean section surgery in Brazil, using this same measurement instrument in the preoperative period. 21 These results differ from the assessments of anxiety and depression performed in recent studies with patients undergoing bariatric surgery and 15 otolaryngologic surgery 16 and with orthopedic and traumatized patients. 17 It is possibly that due to differences in the demographic and clinical profile of the studied patients, in addition to the differences in the validity of the measurement instruments used to assess anxiety and depression, no evidence of validity of the instruments was found in surgical patients in these studies.…”

“…There is strong evidence that preoperative pain has a linear and direct relationship with postoperative pain. [20][21][22] The patients in the present study did not have this risk factor, so it was not possible to verify this cause and effect relationship.…”

“…In general, these data are consistent with the results found in recent studies regarding the perception of pain in the immediate postoperative period. 17,[19][20][21]25 However, the heterogeneity of the studies in relation to the evaluation time and the variability in the type of tools used to assess anxiety and depression makes it difficult to compare data with existing literature.…”

The Effect of Progressive Muscle Relaxation on Post Cesarean Section Pain, Quality of Sleep and Physical Activities Limitation

“…The results of the current study seem to be logic because according to Borges et al (2016) the most common predicator for pain after Cs is activity restriction. Mostly, if the woman in pain she will avoid movement to control pain.…”

“…The pain presented after a Cs makes the recovery difficult and delays mothers' contact with the newborns. It is also, being a hurdle to a good breastfeeding posture, newborn care, self-care, and to carry out daily activities, such as sitting down, standing up, walking, and doing personal hygiene (Borges et al, 2016& Pan et al 2013. The post-cesarean section pain is characterized as acute and is closely related to the damage caused to the tissue due to the inflammatory reactions derived from a traumatic operation.…”