Comparison of postoperative pain severity between primary and repeated cesarean section: a prospective cohort study.

Background: The cesarean section was associated with moderate to severe postoperative pain. Uncertain differences exist between parturient who undergo a primary cesarean section and a repeat cesarean section in terms of post-operative pain.

Objective: To compare the degree of postoperative pain in patients who had primary and repeat cesarean sections.

Method: An institutional-based prospective cohort study was conducted on 336 patients who fulfilled eligibility criteria and underwent caesarian section under spinal anesthesia. Study participants were selected by a systematic random sampling technique. An independent sample t test and a Mann-Whitney U test were used to compare symmetric and asymmetric data, respectively. Time to first analgesic request was analyzed using log rank Kaplan-Meier survival curves and cox-regression for covariates. Comparisons of categorical variables between groups were done using the chi-square test. The significance was determined at a P value of < 0.05.

Results: There was a high Risk of moderate to severe postoperative pain in repeated caesarean section compared to primary caesarean section in both incisional pain (RR, 1.364[95% CI, 1.12-1.66], p = 0.002) and visceral pain (RR, 1.66[95% CI, 1.40-1.66], p = 0.001). In comparison to the primiparas, parturient with repeated cesarean sections had highest post-operative pain severity in NRS with median NRS of 5(IQR, 3-5) at the 4th hour (p < 0.001) for the incisional pain and 6(IQR, 5-7) at the 8th hour for visceral pain, respectively, for the repeated group. The primiparas group had a longer median time to first rescue analgesic administration (median [minute], 875.7[95% CI, 750.3-1001]; P < 0.001)) than the repeated group (median [minute], 534.8 [95% CI, 426.8-642.8]; P < 0.001.

Conclusions: Compared to primary CS, repeated cesarean had a high incidence of moderate to severe postoperative pain, both visceral and incisional; within 48-h. In future endeavors of crafting postoperative analgesic plans, it is imperative to take into account individual variations and distinctions.