Predicting Postcesarean Pain: A Prospective Cohort Study Using a 3-Question Questionnaire, Local Anesthesia Infiltration, and Observer Rating.

Purpose: Acute postoperative pain is a typical complaint following cesarean delivery (CD). The current standard for postcesarean pain management is the use of a multimodal analgesia regimen which is beneficial for many but may be inadequate for some patients. This study aimed to determine if combining patients' response to a pain rating questionnaire, their pain score during local anesthetic infiltration (LAI) preceding spinal anesthesia for CD, and an anesthesiologist's prediction of postcesarean pain severity can predict the intensity of postcesarean pain. Methods: This was a prospective study of ninety women undergoing scheduled CD under spinal anesthesia. Patients completed a pain rating questionnaire preoperatively and rated pain on LAI before spinal injection, and an anesthesiologist predicted the severity of postcesarean pain. Postoperative pain scores were assessed at rest and with movement at 6, 24, and 48 h after surgery. Results: The patient's expected postoperative pain (β = 0.39, p=0.0011), perceived analgesic requirements (β = 0.34, p=0.0002), pain on LAI (β = 0.22, p=0.004), and anesthesiologist's predicted postoperative pain severity (β = 0.22, p=0.01) were associated with mean postoperative pain after CD. The multivariate model analysis found that the pain rating questionnaire and the an anesthesiologist's prediction of postcesarean pain severity contributed to postoperative pain modeling (R ² = 0.27). Conclusion: Combining a preoperative pain rating questionnaire with an anesthesiologist's prediction of postcesarean pain severity accounted for 27% of the variance in mean postoperative pain with movement and may be a useful tool in predicting postcesarean pain. Implications: This study highlights the potential of a combined preoperative pain rating questionnaire and anesthesiologist's predictions to improve postcesarean pain management. By accounting for 27% of the variance in mean postcesarean pain with movement, this approach could enhance pain management outcomes for CD patients.