Post-Cesarean Pain Can Be Forecasted


CHICAGO — Anticipated pain, anxiety, and sensitivity to standardized audio tones can predict a woman's pain experience and narcotic requirements following cesarean section, according to a study of 118 recipients of elective C-sections.

“These findings indicate that simple questions prior to cesarean section can help providers identify patients who may be at risk for inadequate pain control and subsequent development of persistent pain and depression,” Dr. Ashley M. Tonidandel of Wake Forest University, Winston-Salem, N.C., reported at the annual meeting of the Society for Obstetric Anesthesia and Perinatology.

Previous research presented at last year's meeting indicated that pain severity following delivery is a stronger predictor of persistent pain and postpartum depression than is method of delivery.

The link between acute pain and postpartum depression, which can impair the mother's ability to attach to the infant, underscores the need for an easy method of identifying at-risk patients, Dr. Tonidandel commented.

“The Joint Commission suggests that it's both a hospital standard and a patient right to have a goal for pain scores of less than four,” she said.

To date, Dr. Tonidandel and her colleagues have collected data on 118 parturients who underwent elective C-section with subarachnoid anesthesia and spinal morphine.

Most of the patients were undergoing repeat C-sections, and the rest were undergoing primary sections for breech and other reasons.

During the preoperative anesthetic consultation, patients were asked a set of questions regarding their level of anticipated pain and anxiety.

They also rated the loudness of a series of tones with a visual analog scale.

Chart reviews provided data on actual narcotic usage in the postanesthesia care unit and 24 hours after surgery.

Assessments of resting pain, evoked pain, and satisfaction with pain control also were conducted 24 hours after surgery using the same visual analog scale.

Patient scores on anticipated pain, anxiety, and sensitivity to sound predicted levels of narcotic usage in the postanesthesia care unit and at 24 hours post surgery, as well as degree of resting and evoked pain.

Satisfaction with pain control was generally high and was not associated with patient scores.

Anticipated pain surfaced as the most significant predictor of postsurgical pain and analgesic requirements; however, audio sensitivity was an important and unique predictor of narcotic usage in the postanesthesia care unit as well.

Previous research has shown that sensitivity to heat can help predict narcotic requirements after cesarean delivery (Anesthesiology 2006;104:417–25). However, the use of audio stimuli, which were shown to be predictive in this study, provides “a nice way to get around having to use heat on parturients before C-section,” Dr. Tonidandel said.

“By asking patients [a few questions] preoperatively, I'm much less surprised by what happens later,” she added.

As more data are collected, Dr. Tonidandel and her colleagues plan to develop threshold scores to identify patients who might benefit from early intervention and the initiation of customized, multimodal pain management.

The model used in this study also may have potential applications for patients undergoing other types of surgery, they said.

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