A Predictor of Post-Cesarean Pain?

TOPLINE:

A higher intensity of pain during infiltration of local anesthesia during cesarean delivery was associated with increased pain at 24 hours postpartum and lower global health ratings, although the quality of recovery scores remained unaffected.

METHODOLOGY:

• Researchers conducted a prospective observational study at a university-affiliated tertiary care center between August 2019 and September 2023 to evaluate local anesthesia pain as a predictor of severity of post-cesarean pain and recovery quality.
• A total of 114 women (median age, 32 years; 52.6% White) undergoing cesarean delivery with neuraxial anesthesia were included in the final analysis.
• Pain during infiltration of local anesthesia was assessed prior to the neuraxial procedure using a numerical rating scale of 0-100 after lidocaine injection, and participants were categorized into mild (n = 83), moderate (n = 24), and severe (n = 7) pain groups on the basis of their scores.
• The primary outcome was postoperative pain assessed at 24 hours postpartum, using six pain scores (average and peak pain at rest, with movement, and with uterine cramping).
• Secondary outcomes were recovery, assessed using the 11-item Obstetric Quality of Recovery questionnaire (ObsQoR-11), and a global health rating, evaluated with numerical rating scale scores of 0-100, with the numbers indicating worst and best imaginable health states, respectively.

TAKEAWAY:

• Significant differences were found among the three pain groups for all primary outcomes. Average and peak pain at rest (P = .0002 and P = .003, respectively), as well as peak pain during movement (P = .002), were significantly associated with pain during infiltration of local anesthesia.
• Global health ratings were significantly different among the pain groups, but ObsQoR-11 scores were not.
• Only the global health rating showed a significant association with local anesthesia pain (P = .008).
• The study found low sensitivity but high specificity in using pain scores during infiltration of local anesthesia for predicting severe post-cesarean pain and poor recovery at 24 hours post-cesarean delivery.

IN PRACTICE:

“Our findings underscore the potential of ILA [infiltration of local anesthesia] as only one component of a multifactorial approach to predicting postoperative pain,” the researchers reported.

SOURCE:

The study was led by Christine McKenzie, MD, of the University of North Carolina at Chapel Hill. It was published online on June 20, 2025, in the International Journal of Obstetric Anesthesia.

LIMITATIONS:

The single-center design and focus on scheduled cesarean deliveries may limit the generalizability of the findings. The low number of patients reporting severe pain during local anesthesia infiltration may have affected the study’s power. The study did not account for anxiety or other mental health conditions, which may affect the internal validity of the findings.

DISCLOSURES:

The authors reported having no conflicts of interest or funding sources for this study.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.