Incidence, Severity, and Interference of Chronic Postsurgical Pain After Cesarean Delivery: A Systematic Review and Meta-analysis

IF 5 2区医学 Q1 ANESTHESIOLOGY

Journal of Clinical Anesthesia Pub Date : 2025-04-24 DOI:10.1016/j.jclinane.2025.111832

Sarah Ciechanowicz MA, BMBCh, MRes , Rebekah Reville Joy BA (Hons), PGCert , Julia Kasmirski MD , Lindsay Blake EdD, MLIS, AHIP , Brendan Carvalho MBBCh , Pervez Sultan MBChB, MD(Res)

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引用次数: 0

Abstract

Background

Chronic postsurgical pain (CPSP) is a common complication following surgery. Cesarean delivery (CD) is the most performed inpatient surgery, however, the true incidence of CPSP after CD in contemporary practice is unknown. This systematic review and meta-analysis aimed to determine the incidence and severity of CPSP after CD and assess interference with maternal health-related quality of life (HR-QoL).

Methods

A 7-database literature search was used to identify observational and randomized controlled studies (RCTs) reporting the incidence of CPSP following CD (published January 2015 to August 2023). Included studies were added to the 29 studies identified from a prior review published in 2016. The primary outcome was incidence of CPSP (wound, scar or abdomen) between ≥3 to <6 months, ≥6 to <12, and ≥ 12 months. Secondary outcomes were incidence of chronic pain (back, pelvis or other residual); pain intensity at rest and movement-evoked, and chronic pain interference with maternal HR-QoL at each time interval.

Results

50 studies involving 13,149 patients were included. Meta-analysis with random-effects model (n = 9228; 9 RCTs and 20 observational) revealed an incidence of scar-specific CPSP of 16.7 % (C·I. 13.1 to 20.4 %; I² = 97.0 %; p < 0.001) at ≥3 to <6 months, 11.4 % (95 % CI 8.7 to 14.0 %; I² = 94.1 %; P < 0.001) at ≥6 to <12 months, and 8.8 % (95 % CI 6.6 to 11.0 %; I² = 97.3 %; P < 0.001) at ≥12 months. Meta-regression analysis using publication year as the co-variate revealed a stable CPSP incidence from 2002 onwards. Between ≥6 to <12 months, 51.2 % (95 % C·I: 18.7 to 83.8 %) and 13.5 % (95 % C·I: 0 to 27.1 %) of women had mild and severe pain at rest, respectively. CPSP interfered with HR-QoL in all 7 subdomains of the Brief Pain Inventory in the majority (>50 %) of patients. Walking ability was impacted in 67.6 % (95 % CI 57.6 to 77.6 %; I² = 50 %) at ≥3 to <6 months. Normal work was impacted in 69.4 % (95 % CI 59.3 to 79.6 %; I² = 18.6 %) and enjoyment of life in 79.5 % (67.1 to 91.9 %; I² = 59.3 %) at ≥6 to <12 months. Therefore an estimated 10 % of patients experience CPSP after CD that interferes with daily life, work, social life and personal care. The GRADE quality of evidence was rated as very low for all outcomes.

Conclusions

CPSP after CD occurs in 16.7 % of patients at ≥3 to <6 months postpartum and widely interferes with maternal HR-QoL domains in the majority of those affected. Further studies are required to explore potential mitigating factors and optimal treatment strategies.

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剖宫产后慢性术后疼痛的发生率、严重程度和干扰：系统回顾和荟萃分析

背景：慢性术后疼痛（CPSP）是手术后常见的并发症。剖宫产是最常见的住院手术，然而，剖宫产后CPSP的真实发生率在当代实践中尚不清楚。本系统综述和荟萃分析旨在确定CD后CPSP的发生率和严重程度，并评估与孕产妇健康相关的生活质量（HR-QoL）的干扰。方法采用7个数据库的文献检索，筛选2015年1月至2023年8月发表的报告CD后CPSP发生率的观察性和随机对照研究（RCTs）。纳入的研究被添加到2016年发表的先前综述中确定的29项研究中。主要终点为CPSP（伤口、疤痕或腹部）发生率≥3 ~ 6个月、≥6 ~ 12个月和≥12个月。次要结局是慢性疼痛（背部、骨盆或其他残余疼痛）的发生率；静息和运动诱发的疼痛强度，以及慢性疼痛对产妇HR-QoL的干扰。结果纳入50项研究，13149例患者。随机效应模型荟萃分析(n = 9228；9项随机对照试验和20项观察性研究显示，疤痕特异性CPSP的发生率为16.7% (C·I。13.1 ~ 20.4%；i2 = 97.0%；p & lt;0.001)，在≥3 ~ 6个月时，11.4% (95% CI 8.7 ~ 14.0%；i2 = 94.1%；P & lt;0.001)≥6 ~ 12个月，8.8% (95% CI 6.6 ~ 11.0%；i2 = 97.3%；P & lt;0.001)，≥12个月。以出版年份为协变量的meta回归分析显示，自2002年以来CPSP发病率稳定。在≥6 ~ 12个月期间，分别有51.2% （95% C·I: 18.7 ~ 83.8%）和13.5% （95% C·I: 0 ~ 27.1%）的女性在休息时出现轻度和重度疼痛。在大多数（50%）患者中，CPSP干扰了简短疼痛量表的所有7个亚域的HR-QoL。行走能力受到影响的占67.6% (95% CI 57.6 ~ 77.6%；I2 = 50%)≥3 ~ 6个月。正常工作受到影响的占69.4% (95% CI 59.3 ~ 79.6%；I2 = 18.6%)和79.5% (67.1 ~ 91.9%；I2 = 59.3%)≥6 ~ 12个月。因此，估计有10%的患者在CD后经历CPSP，干扰日常生活、工作、社交生活和个人护理。所有结果的GRADE证据质量都被评为非常低。结论产后3 ~ 6个月发生scpsp的患者占16.7%，并对产妇的HR-QoL域有广泛干扰。需要进一步的研究来探索潜在的缓解因素和最佳的治疗策略。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Clinical Anesthesia 医学-麻醉学

CiteScore

7.40

自引率

4.50%

发文量

346

审稿时长

23 days

期刊介绍： The Journal of Clinical Anesthesia (JCA) addresses all aspects of anesthesia practice, including anesthetic administration, pharmacokinetics, preoperative and postoperative considerations, coexisting disease and other complicating factors, cost issues, and similar concerns anesthesiologists contend with daily. Exceptionally high standards of presentation and accuracy are maintained. The core of the journal is original contributions on subjects relevant to clinical practice, and rigorously peer-reviewed. Highly respected international experts have joined together to form the Editorial Board, sharing their years of experience and clinical expertise. Specialized section editors cover the various subspecialties within the field. To keep your practical clinical skills current, the journal bridges the gap between the laboratory and the clinical practice of anesthesiology and critical care to clarify how new insights can improve daily practice.