Pain and adverse effects after caesarean delivery: A nationwide prospective cohort study.

IF 6.8 2区医学 Q1 ANESTHESIOLOGY

European Journal of Anaesthesiology Pub Date : 2025-09-15 DOI:10.1097/EJA.0000000000002277

Patricia Duch, Anne Wikkelsø, Christoffer C Jørgensen, Janus C Jakobsen, Ole Mathiesen, Anders K Nørskov, Helene Nedergaard

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引用次数: 0

Abstract

Background: Caesarean delivery can cause severe postoperative pain that can adversely affect recovery. However, balancing effective pain management while minimising the risk of opioid-related adverse effects remains a clinical challenge.

Objective: In this nationwide study, we aimed to describe the incidence and severity of acute pain and adverse effects of opioid administration following the first hours and days after elective caesarean delivery.

Design: Prospective nationwide Danish multicentre cohort study.

Setting: All maternity hospitals in Denmark over a 6-month period during 2023-2024.

Patients: Patients having elective caesarean delivery.

Intervention: Patient-reported outcomes on pain [Numeric Rating Scale (NRS) 0 to 10] and opioid-related adverse effects were collected using text message-based questionnaires via smartphone contact at 6, 12, 18, 24, and 48 h postcaesarean delivery, and on days 7 and 30.

Main outcome measures: The two primary outcomes were pain on mobilisation at 24 h, and adverse events of opioid administration (namely, nausea, vomiting, dizziness, pruritus and urinary retention) within 24 h.

Results: In total, 738 patients were included from 19 of 22 Danish maternity hospitals. Median [IQR] pain during mobilisation 24 h postcaesarean delivery was NRS 5 [3 to 6], peaking at 12 h postoperatively with NRS 6 [5 to 8]. Median oral morphine equivalents (OME) within the first 24 h were 30 [20 to 50] mg. Adverse effects peaked 6 h postoperatively, with pruritus being the most common. Within the first 24 h 59 [95% confidence interval (CI), 55 to 63]% reported severe pain (NRS ≥ 7) and 55 (95% CI, 51 to 59)% reported opioid-related adverse effects.

Conclusions: In Denmark, severe pain after caesarean delivery affects more than half the patients within the first 24 h, peaking at 12 h. Additionally, most report moderate or severe opioid-related adverse effects. These results underscore the need to optimise pain management, particularly during the first 24 h when pain is highest. The results can inform both patients and healthcare providers about expected pain trajectories and serve as the foundation for future research, and guide interventions.

Trial registration: www.clinicaltrials.gov , NCT06012747.

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剖宫产后疼痛和不良反应：一项全国前瞻性队列研究。

背景：剖宫产可引起严重的术后疼痛，对恢复有不利影响。然而，平衡有效的疼痛管理，同时尽量减少阿片类药物相关不良反应的风险仍然是一个临床挑战。目的：在这项全国性的研究中，我们旨在描述选择性剖宫产后最初几个小时和几天内急性疼痛的发生率和严重程度以及阿片类药物的不良反应。设计：前瞻性丹麦全国多中心队列研究。背景：在2023-2024年期间的6个月期间，丹麦所有妇产医院。患者：择期剖宫产患者。干预措施：在剖腹产后6、12、18、24和48小时，以及第7和30天，通过智能手机联系，使用基于短信的问卷收集患者报告的疼痛[数值评定量表（NRS） 0至10]和阿片类药物相关不良反应的结果。主要结局指标：两个主要结局是24小时活动时疼痛，以及24小时内阿片类药物给药不良事件（即恶心、呕吐、头晕、瘙痒和尿潴留）。结果：共纳入了来自丹麦22家妇产医院中的19家的738名患者。剖宫产后24小时活动时疼痛中位数为NRS 5[3 ~ 6]，在术后12小时达到峰值，NRS 6[5 ~ 8]。前24小时口服吗啡当量（OME）中位数为30 [20 ~ 50]mg。不良反应在术后6小时达到高峰，以瘙痒最为常见。在最初的24小时内，59%[95%可信区间（CI）， 55 - 63]%报告了严重疼痛（NRS≥7），55% (95% CI, 51 - 59)%报告了阿片类药物相关的不良反应。结论：在丹麦，超过一半的患者在剖腹产后24小时内出现剧烈疼痛，在12小时达到高峰。此外，大多数报告中度或重度阿片类药物相关不良反应。这些结果强调了优化疼痛管理的必要性，特别是在疼痛最高的前24小时。结果可以告知患者和医疗保健提供者有关预期的疼痛轨迹，并作为未来研究的基础，并指导干预措施。试验报名：www.clinicaltrials.gov, NCT06012747。

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

European Journal of Anaesthesiology 医学-麻醉学

CiteScore

6.90

自引率

11.10%

发文量

351

审稿时长

6-12 weeks

期刊介绍： The European Journal of Anaesthesiology (EJA) publishes original work of high scientific quality in the field of anaesthesiology, pain, emergency medicine and intensive care. Preference is given to experimental work or clinical observation in man, and to laboratory work of clinical relevance. The journal also publishes commissioned reviews by an authority, editorials, invited commentaries, special articles, pro and con debates, and short reports (correspondences, case reports, short reports of clinical studies).