Predicting pain after Cesarean delivery: pressure algometry, temporal summation, three-item questionnaire

Area of Science:

• Anesthesiology
• Pain Medicine
• Obstetrics

Background:

• Severe postoperative pain affects approximately 20% of women after Cesarean delivery (CD).
• A bedside three-item questionnaire (3-IQ) previously predicted higher pain intensity post-CD with an AUC of 0.72.
• Predicting severe pain is essential for effective pain management strategies.

Purpose of the Study:

• To determine if adding psychophysical pain tests to the 3-IQ improves prediction of severe postoperative pain after elective CD.
• To evaluate the predictive performance of the 3-IQ alone versus the 3-IQ combined with pressure algometry (PA) and temporal summation (TS).

Main Methods:

• Prospective cohort study of 195 women undergoing elective CD under spinal anesthesia.
• Preoperative assessment included the 3-IQ, PA, and TS.
• Postoperative pain severity (VASr, VASm), patient satisfaction, and opioid consumption were recorded.

Main Results:

• The median VASm24 was 53, with 28% of patients experiencing severe pain (VASm24 ≥ 70).
• The area under the ROC curve (AUC) for predicting severe pain was 0.64 for the 3-IQ alone.
• The AUC for the 3-IQ combined with PA and TS was 0.67, showing minimal improvement.

Conclusions:

• The addition of PA and TS to the 3-IQ did not significantly enhance the prediction of severe postoperative pain after CD.
• Further research is needed to develop more accurate models for identifying women at risk of severe pain post-CD.