Abstract
Background
Intraoperative pain is a possible complication of neuraxial anesthesia for Cesarean delivery. There is little information available about its incidence, risk factors and physician perception.
Methods
Parturients undergoing spinal anesthesia for elective Cesarean delivery were enrolled. Before surgery, parturients were asked about preoperative anxiety on a verbal numerical scale (VNS), anticipated analgesic requirement, postoperative pain levels, Spielberger STATE-TRAIT inventory index, Pain Catastrophizing Scale. After surgery, parturients were asked to answer questions (intraoperative VNS pain). The anesthesiologist and obstetrician were asked to fill out a questionnaire asking about perceived intraoperative pain. Influence of preoperative anxiety on intraoperative pain (yes/no) was assessed using logistic regression. Mc Fadden’s R2 was calculated. The agreement in physician perception of intraoperative pain with reported pain by the parturient was examined by calculating Cohen’s kappa and 95% Confidence Intervals (CI).
Results
We included 193 parturients in our analysis. Incidence of intraoperative pain was 11.9%. Median intraoperative VNS pain of parturients with pain was 4.0 (1st quartile 4.0; 3rd quartile 9.0). Preoperative anxiety was not a good predictor of intraoperative pain (p-value of b-coefficient= 0.43, Mc Fadden’s R2= 0.01). Including further preoperative variables did not result in a good prediction model. Cohen’s kappa between reported pain by parturient and by the obstetrician was 0.21 (95% CI; 0.01, 0.41) and by the anesthesiologist was 0.3 (95% CI; 0.12, 0.48).
Conclusions
We found a substantial incidence (11.9%) of intraoperative pain during Cesarean delivery. Preoperative anxiety did not predict intraoperative pain. Physicians did not accurately identify parturients’ intraoperative pain.
from Wiley: European Journal of Pain: Table of Contents https://ift.tt/3mEuXLZ
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