A prospective observational study to investigate the relationship between local anesthetic infiltration pain before spinal anesthesia and acute and chronic postsurgical pain in women undergoing elective cesarean delivery. (February 2021)

• Record Type: Journal Article
• Authors: Nimmaanrat, S.; Wongwiwattananon, W.; Siripreukpong, S.; Chongsuvivatwong, V.; Jensen, M.P.
• Is Part Of: International journal of obstetric anesthesia. Volume 45(2021)
• Page Start: 56
• Page End: 60
• Publication Date: 2021-02
• Subjects: Acute postoperative pain -- Cesarean delivery -- Chronic postsurgical pain -- Infiltration pain; Obstetrics -- Periodicals; Anesthesia -- Periodicals; Anesthésie en obstétrique -- Périodiques; Anesthesia; Obstetrics; Electronic journals; Periodicals; 617.9682
• DOI: 10.1016/j.ijoa.2020.11.003
• Languages: English
• ISSNs: 0959-289X

Abstract

Highlights: Study correlating local anesthetic infiltration (LAI) pain and postsurgical pain. Infiltration pain predicts acute postoperative pain after elective cesarean delivery. It also weakly correlates with pain after one month. Personalized pain relief strategies based on LAI pain should be explored. Abstract: Background: Cesarean delivery is one of the most common procedures performed worldwide. We conducted this prospective cohort study to evaluate the association between local anesthetic infiltration (LAI) pain prior to spinal anesthesia and pain and morphine consumption within 24 h after cesarean delivery (primary outcomes). A secondary objective was to assess the association between LAI pain and pain at one month postoperatively. Methods: Recruitment of 216 eligible women scheduled for elective cesarean delivery. Local infiltration before spinal anesthesia was performed using a 24-gauge needle and 3 mL 2% plain lidocaine. All subjects received 2.2 mL 0.5% hyperbaric bupivacaine with 200 µg morphine for spinal anesthesia. A 0–10 verbal numerical rating scale was used to assess LAI pain severity, and subsequent pain at 24 h, 1, 3 and 12 months. Results: We found a moderate correlation between LAI pain intensity and severity of acute pain at rest (rho=0.56, P <0.001) and with movement (rho=0.58, P <0.001) and a weak correlation with morphine consumption (rho=0.17, P =0.01) within 24 h postoperatively. We also found a positive correlation between LAI pain and the severity of persistent wound pain at rest (rho=0.30, P <0.001) and with movement (rho=0.52, P <0.001) at 1 month. The incidence of wound pain at 1, 3 and 12 months postoperatively was 37.1%, 7.0% and 1.4%, respectively. Conclusions: Pain from LAI prior to spinal anesthesia is significantly associated with subsequent postoperative pain both acutely and at one month in women scheduled for elective cesarean delivery under spinal anesthesia.