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Minerva Anestesiologica 2021 Aug 02

DOI: 10.23736/S0375-9393.21.15654-8


language: English

Neuropathic component of postoperative pain for predicting post-caesarean chronic pain at three months. A prospective observational study

María C. RODRÍGUEZ ROCA 1 , Nicolas BROGLY 1, Elena GREDILLA DIAZ 1, Paula PINEDO GIL 1, Jesús DIEZ 2, Emilia GUASCH 1, Fernando GILSANZ RODRÍGUEZ 1

1 Department of Anesthesiology and Intensive Care Medicine, La Paz University Hospital, Madrid, Spain; 2 Department of biostatistics, La Paz University Hospital, Madrid, Spain


BACKGROUND: Recent investigations have showed that caesarean section (CS) might be a cause of chronic pain, with a consequent decrease in quality of life.
METHODS: Prospective observational study in a Spanish tertiary hospital. Main Outcome measure was to assess early neuropathic characteristics of pain (DN2 score ≥ 3) one week after CS as a potential risk factor for post-caesarean section chronic pain (PCSCP) at three months. Secondary outcome was to identify other risk factors. 610 consecutive consenting patients undergoing CS were interviewed preoperatively, at discharge from recovery room and 24h postoperatively. Telephone follow-up interviews were conducted one week, three months and twelve months following surgery.
RESULTS: We analysed 597 consecutive patients. The incidence of PCSCP at three and twelve postoperative months were 6.2% and 1% respectively. Subjects with NRS score superior to five on movement one week after CS presented higher incidence of PCSCP (NRS superior to five: 19 (52,2%); NRS equal or lower to five: 172 (30,9%); p=0,009). On multivariate analysis neuropathic pain one week after CS was associated with a higher risk of PCSCP (AOR: 1.63 (95% CI: 1.26-2.11; p<0.001). Other identified risk factors for PCSCP were: uterine exteriorization during CS (AOR: 3.89 (95% CI 1.25-12.10; p=0.019) and a lower gestational age (AOR: 0.87 (95% CI: 0.78-0.96; p=0.008).
CONCLUSIONS: Incidence of PCSCP at three and twelve postoperative months was low, 6.2% and 1% respectively. Early neuropathic characteristics of pain after one week measured by neuropathic pain questionnaire, consisting of two questions (DN2) ≥ 3/7 could be used to identify patients at risk for chronic post-surgical pain and develop preventive strategies.

KEY WORDS: Caesarean section; Chronic postsurgical pain; Neuropathic pain

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