Comparison of postoperative pain between patients who underwent primary and repeated cesarean section: a prospective cohort study

Guangyou Duan, Guiying Yang, Jing Peng, Zhenxin Duan, Jie Li, Xianglong Tang, Hong Li, Guangyou Duan, Guiying Yang, Jing Peng, Zhenxin Duan, Jie Li, Xianglong Tang, Hong Li

Abstract

Background: The differences in post-operative pain are unclear between the primiparas who underwent a primary cesarean section and multiparas who underwent their first repeat cesarean section. The study aimed to explore the possible differences in postoperative pain between primiparas and multiparas.

Methods: A prospective cohort study was performed only including women who underwent cesarean deliveries under spinal anesthesia. Postoperative patient-controlled intravenous analgesia (PCIA) was administered to all subjects with 0.2 mg/kg hydromorphone and 4 mg/kg flurbiprofen; the pump was programmed as 2.0 mL/h background infusion with a loading dose of 1 mL and a lockout period of 15 min. Postoperative incision and visceral pain intensity were evaluated using the visual analogue scale, and inadequate analgesia was defined as a visual analogue scale score ≥ 40 during 48 h post-operation. Additionally, the patients' pain statuses in postoperative week 1 and week 4 were also assessed during follow-up via telephone.

Results: From January to May 2017, a total of 168 patients (67 primiparas and 101 multiparas) were included. The relative risk for multiparas to experience inadequate analgesia on incision pain was 0.42 (95% CI: 0.25 to 0.74) compared to primiparas. In patients aged < 30 years, inadequate analgesia on visceral pain was higher in multiparas than in primiparas (RR, 3.56 [1.05 to 12.04], P = 0.025). There was no significant difference in the combined incidence of inadequate analgesia in both types of pain between the multiparas and primiparas (33.7% vs. 40.2%, P = 0.381). No difference was found in PCIA use between the two groups (111.1 ± 36.0 mL vs. 110.9 ± 37.3 mL, P = 0.979). In addition, a significantly higher incidence of pain was noted 4 weeks post-surgery in primiparas than that in multiparas (62.2% vs. 37.7%, P = 0.011).

Conclusion: Multiparas who underwent their first repeat cesarean section have a lower for inadequate analgesia on incision pain during the first 48 h after surgery than primiparas. Multiparas aged under 30 years may be more prone to experiencing postoperative inadequate analgesia on visceral pain.

Trail registration: ClinicalTrial.gov: NCT03009955 , Date registered: December 30, 2016.

Keywords: Analgesia; Cesarean section; Multiparas; Postoperative pain; Primiparas.

Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
The flow diagram of the study
Fig. 2
Fig. 2
The distribution of postoperative incision pain VAS at rest (a) incision pain VAS at mobilization (b) and visceral pain VAS (c) at different time points. Means of groups P and R patients who received primary and repeated cesarean section, respectively; VAS = visual analogue scale; PO = postoperative; * P < 0.05; ** P < 0.01
Fig. 3
Fig. 3
The incidence of postoperative inadequate treatment on incision pain (a), visceral pain (b) and the combined incidence (c) Groups P and R represent patients who underwent primary and repeated cesarean sections, respectively; VAS = visual analogue scale; PO = postoperative.
Fig. 4
Fig. 4
Changes in leukocyte count (a) and neutrophil count (b) before and after surgery. Means of groups P and R patients who underwent primary and repeated cesarean sections, respectively; Pre = preoperative; PO = postoperative; *** compared to group R, P < 0.001.

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