Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2025 Jul 1;143(1):156-167.
doi: 10.1097/ALN.0000000000005486. Epub 2025 Apr 4.

Intraoperative Pain during Cesarean Delivery under Neuraxial Anesthesia: A Systematic Review and Meta-analysis

Elinor A Charles  1 , Hester Carter  1 , Susanna Stanford  2 , Lindsay Blake  3 , Victoria Eley  4 , Brendan Carvalho  5 , Pervez Sultan  5 , Justin Kua  6 , James E O'Carroll  7
Affiliations
Meta-Analysis

Intraoperative Pain during Cesarean Delivery under Neuraxial Anesthesia: A Systematic Review and Meta-analysis

Elinor A Charles et al. Anesthesiology. .

Abstract

Background: Neuraxial anesthesia is the definitive standard technique for cesarean delivery; however, pain during cesarean delivery may be underreported. The primary aim of this systematic review and meta-analysis was to determine the incidence of patient-reported intraoperative pain during cesarean delivery under neuraxial anesthesia.

Methods: A literature search of databases (PubMed, MEDLINE, Embase, Web of Science, Scopus, Cochrane Database of Systematic Reviews, and Central Register of Controlled Trials) was conducted. Search topics included terminology concerning cesarean delivery, neuraxial anesthesia, pain, and incidence. Meta-analyses were performed to calculate pooled incidences of patient-reported pain and how mode of anesthesia influenced the incidence of patient-reported pain, with included articles assessed for risk of bias.

Results: A total of 2,061 abstracts were screened; 34 articles were included (21 randomized studies and 13 nonrandomized studies). The crude incidence of intraoperative pain under neuraxial anesthesia was 10.8% (1,229 of 11,351 patients), and the pooled incidence was 17% (95% CI, 13 to 22%; 1,229 of 11,351 patients). Patients who received spinal anesthesia had the lowest pooled incidence of pain of 14% (95% CI, 10.0 to 20.0%; 662 of 8,002 patients), and those who received epidural top-up had the highest pooled incidence of pain of 33% (95% CI, 17.0 to 54.0%; 253 of 1,395 patients). Risk of bias assessments showed high risk of bias in half of the included studies.

Conclusions: Patient-reported pain during cesarean delivery under neuraxial anesthesia is common, with spinal and combined spinal-epidural anesthesia reporting a lower incidence of pain than epidural anesthesia. Intraoperative pain can have significant psychologic impact for patients and medicolegal implications for providers. Further prospective studies are required to characterize and understand the impact of patient experiences of pain and develop techniques to reduce this complication.

PubMed Disclaimer

References

    1. Betran AP, Ye J, Moller AB, Souza JP, Zhang J: Trends and projections of caesarean section rates: Global and regional estimates. BMJ Glob Health 2021; 6:e005671. doi:10.1136/bmjgh-2021-005671 - DOI
    1. Lumbiganon P, Moe H, Kamsa-ard S, et al.: Outcomes associated with anaesthetic techniques for caesarean section in low- and middle-income countries: A secondary analysis of WHO surveys. Sci Rep 2020; 10:10176. doi:10.1038/s41598-020-66897-8 - DOI
    1. Keita H, Deruelle P, Bouvet L, et al.: Raising awareness to prevent, recognise and manage acute pain during caesarean delivery: The French practice bulletin. Anaesth Crit Care Pain Med 2021; 40:100934. doi:10.1016/j.accpm.2021.100934 - DOI
    1. Pan PH, Bogard TD, Owen MD: Incidence and characteristics of failures in obstetric neuraxial analgesia and anesthesia: A retrospective analysis of 19,259 deliveries. Int J Obstet Anesth 2004; 13:227–33. doi:10.1016/j.ijoa.2004.04.008 - DOI
    1. Kinsella SMA: Prospective audit of regional anaesthesia failure in 5080 Caesarean sections. Anaesthesia 2008; 63:822–32. doi:10.1111/j.1365-2044.2008.05499.x - DOI

MeSH terms