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Intraoperative Pain during Cesarean Delivery under Neuraxial Anesthesia: A Systematic Review and Meta-analysis
Elinor A Charles1, Hester Carter1, Susanna Stanford2
1Department of Anaesthesia and Perioperative Medicine, University College London Hospital, London, United Kingdom.
Anesthesiology
|April 4, 2025
Summary
Patient-reported pain during cesarean delivery under neuraxial anesthesia is common, affecting 17% of patients. Spinal anesthesia showed the lowest incidence, while epidural anesthesia had the highest, indicating a need for improved pain management strategies.
Area of Science:
- Anesthesiology
- Obstetrics
- Pain Medicine
Background:
- Neuraxial anesthesia is standard for cesarean delivery, but intraoperative pain may be underreported.
- Understanding patient-reported pain incidence is crucial for improving surgical experiences.
Purpose of the Study:
- To determine the incidence of patient-reported intraoperative pain during cesarean delivery under neuraxial anesthesia.
- To compare pain incidence across different neuraxial anesthesia techniques.
Main Methods:
- Systematic review and meta-analysis of multiple databases (PubMed, Embase, etc.).
- Inclusion of 34 studies (21 randomized, 13 non-randomized) after screening 2,061 abstracts.
- Meta-analysis to calculate pooled incidences and assess risk of bias.
Main Results:
- Pooled incidence of intraoperative pain was 17% (95% CI, 13-22%).
- Spinal anesthesia had the lowest pain incidence (14%), while epidural top-up had the highest (33%).
- High risk of bias was noted in 50% of the included studies.
Conclusions:
- Patient-reported pain during cesarean delivery under neuraxial anesthesia is prevalent.
- Spinal and combined spinal-epidural anesthesia are associated with lower pain incidence than epidural anesthesia.
- Further research is needed to understand pain impact and develop reduction techniques.
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