Pain severity during infiltration of local anesthesia before spinal anesthesia as a predictor of post-cesarean pain and Obstetric Quality-of-Recovery scores (ObsQoR-11): a prospective observational study

Abstract

Background

Pain during infiltration of local anesthesia (ILA) before spinal anesthesia is a clinical measure shown to predict post-cesarean pain. We evaluated ILA as a predictor of post-cesarean pain and functional recovery.

Methods

Patients undergoing cesarean delivery with neuraxial anesthesia were recruited. Pain during ILA (lidocaine 1% 3 mL) was assessed with numerical rating scale (NRS; 0–100). At 24 hours postpartum, six NRS pain scores (average and peak pain at rest, movement, and uterine cramping), ObsQoR-11 and global health rating were recorded. Outcome data compared three groups according to pain during ILA: mild (≤30), moderate (31–69), and severe (≥70). Principal component analysis was used to determine the number of effective independent tests and P value thresholds (resulting in significant P <0.017 for primary outcomes and P <0.013 for other outcomes).

Results

Of 114 participants, 83 (72.8%) had mild ILA, 24 (21.1%) had moderate ILA, and 7 (6.1%) had severe ILA. Median rest pain was 20.0 (95% CI 10.0 to 20.0) in mild ILA group, 35 (95% CI 20.0 to 50.0) in moderate ILA group, and 45.0 (95% CI 30.0 to 60.0) in severe ILA group (P <0.001). Median ObsQoR-11 score was not significantly different between groups (90.0 (95% CI 83.0 to 92.0), 74.0 (95% CI 65.0 to 79.0), and 88.0 (95% CI 58.0 to 90.0), respectively; P = 0.021). Median global health rating at 24 hours was 70.0 (95% CI 70.0 to 73.0), 60.0 (95% CI 50.0 to 67.5), and 70.0 (95% CI 40.0 to 80.0), respectively (P =0.010).

Discussion

Our findings suggest that pain during ILA may serve as a clinical predictor of post-cesarean pain; however, it was not associated with lower ObsQoR-11 scores.