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. 2025 Jun 30;14(13):4638.
doi: 10.3390/jcm14134638.

Assessing the Experience and Management of Acute Post-Operative Pain from Caesarean Delivery: A Multi-Centre Cohort Study

Carles Espinós Ramírez  1   2 , Gisela Roca Amatria  3 , Pere Castellví Obiols  2 , David Martínez-Rodríguez  4 , Mireia Raynard  5 , Blanca Viscasillas Draper  1 , Paula Masgoret  6 , Cristina Rodríguez Cosmen  7 , Laura Subirana Giménez  8 , Maria Martinez García  2   9 , Gerard Mestres  10 , Martha Melo  10 , Alèxia Nebot Galindo  11 , Natàlia Montero Gaig  12 , Virginia Sánchez-Migallón  13 , David Valencia Royo  1 , Nuria Lara Pacheco Comino  1 , Inés Bermejo Perez  1 , Cristina Santos Farré  1 , Lluís Toll Salillas  1 , Arnau Alonso Gelabert  1 , Marta Homs  5 , Patricia Ribas  5 , Claudia Teixell  5 , Ana María Plaza Moral  6 , Bea Tena  6 , Adrián Fernández Castiñeira  7 , Mireia Armengol Gay  7 , Beatriz Fort Pelai  7 , Carolina García Bartoló  8 , Carolina Mestre Iniesta  8 , Anna Peig Font  2   9 , Paula Gil Esteller  2   14 , Jean Louis Clave  15 , Sandra Gasca Pera  15 , Astrid Batalla  10 , Verónica Vargas Raidi  11
Affiliations

Assessing the Experience and Management of Acute Post-Operative Pain from Caesarean Delivery: A Multi-Centre Cohort Study

Carles Espinós Ramírez et al. J Clin Med. .

Abstract

Background: Caesarean section is considered one of the surgeries with the highest prevalence of postoperative pain, yet this is often underestimated and undertreated. This study was aimed at evaluating the prevalence and severity of postoperative pain, assessing which analgesic strategy is the most effective and identifying those risk factors associated with poorer analgesic results. Methods: A multi-centre observational study was conducted on 514 women undergoing elective caesarean section. The primary endpoints included postoperative pain severity at rest and with movement at 6 and 24 h. Results: The combination of intrathecal morphine and fentanyl with acetaminophen and Non Steroid Anti-inflammatory Drugs (NSAIDs) was associated with better pain control than any of the following treatments: intrathecal fentanyl with systemic acetaminophen and NSAIDs (2.49 ± 2.04 vs. 3.91 ± 2.75, ES = -0.610, p = 0.01), elastomeric pump at 6 h at rest (2.49 ± 2.04 vs. 4.10 ± 2.86, ES -0.733, p = 0.04) and with movement (4.44 ± 2.41 vs. 6.14 ± 3.08, ES -0.671, p = 0.01) or epidural analgesia (4.44 ± 2.41 vs. 5.65 ± 2.57, ES -0.496, p = 0.02). No risk factors predicting poorer postoperative analgesia were found. Conclusions: The prevalence of postoperative pain control after elective caesarean section is high. The best analgesic postoperative regimen includes intrathecal morphine together with fentanyl and systemic analgesics. No risk factors associated with poorer outcomes were found.

Keywords: analgesia; caesarean section; obstetric; pain; pain measurement; postoperative.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Boxplots of pain distribution by anaesthesia technique. Statistical differences between the distributions and the p value of the test are shown above the boxplots.
Figure 2
Figure 2
Histogram of pain distribution by anaesthesia and analgesia dose. Statistical differences between the distributions and the p value of the test are shown above the boxplots.
See this image and copyright information in PMC

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