Acute Postoperative Pain After Caesarean Section, Intensity and Management: A Cohort Multicentre Study

BACKGROUND: Chronic postsurgical pain (CPSP) following caesarean delivery remains poorly studied despite being one of the most common surgeries and its potential devastating consequences on patients and their newborn babies. We conducted a prospective evaluation of data from a large multicentric cohort to calculate its prevalence, describe its characteristics, risk factors associated and measure its consequences on patients' quality of life and daily functioning. METHODS: A prospective multicentre observational study with women undergoing elective caesarean section. All participants were contacted at 3 months postoperatively to assess the presence or absence of persistent pain. Pain patients were assessed in person to collect data from a focused clinical interview, a targeted physical exam and a set of comprehensive quality of life and functional questionnaires. RESULTS: CPSP was diagnosed in 69 women (14.59%) of the 514 total participants. Most (94.20%) described their pain with somatic-like characteristics. 46.38% also screened positive for neuropathic features and 41.51% fulfilled diagnostic criteria for chronic pelvic pain. Preoperative SF-12 and catastrophic scale and worse postoperative pain at 24 h were related to a higher risk of developing CPSP. Patients with CPSP reported moderate interference in mood, general activity and occupational functioning being more severe in patients with neuropathic pain. CONCLUSIONS: The prevalence of persistent pain after caesarean delivery is noticeably high for such a common, simple and benign surgical procedure. A subset of patients develops mixed neuropathic pain and chronic pelvic pain syndromes. CPSP causes a significant negative impact on quality of life, particularly among patients with neuropathic symptoms. SIGNIFICANCE STATEMENT: This manuscript presents the analysis of the results of a multicentre study regarding the prevalence of CPSP after a caesarean section. Moreover, we have also looked for clinical characteristics of CPSP and its effects on quality of life and daily functioning. The study we describe provides new insights about which the incidence, type, location of CPSP after a caesarean section and association with chronic pelvic pain. It also shows the impact that having CPSP has on these patients' quality of life and activities of daily living.