Intraoperative pain during cesarean delivery: a qualitative concept elicitation study

Qualitative studies surrounding patient experiences of intraoperative pain during cesarean delivery (PDCD) are lacking. The primary outcome of this study was to identify themes that describe experiences of PDCD performed under neuraxial anesthesia from the patients' perspective. Secondary outcomes were to provide exemplar quotations for themes identified and summarize patient experiences.

This prospective qualitative study included semi-structured interviews of patients who delivered at Lucille Packard Children's Hospital, Stanford, California, between 2023 and 2024. Consenting participants were English-speaking, 18-50 years old, who received a primary neuraxial anesthetic for CD of a live infant with a gestational age at time of delivery ≥25 weeks and reported PDCD on postpartum day 1 to 3. Recorded interviews occurred on postpartum day 1, 2 or 3, and patients were screened for post-traumatic stress symptoms and depression with PCL-5 and EPDS questionnaires during inpatient admission and at 6-weeks postpartum and referred to psychiatry services if indicated.

Ten interviews were completed. Seven participants delivered via scheduled CD and three via intrapartum CD. Nine domains were proposed for the construct of PDCD: patient expectations, anesthesia care on the labor and delivery unit, interactions with staff, obstetric variables, anesthesia care in the operating room, patient impression of the anesthesia provider, testing of the block, maternal psychological state, and sensations during surgery. Four patients were referred to psychiatry services for follow up care.

These findings can help guide future research efforts designed to improve counseling, prevention and management of PDCD, and highlight the need to determine the long-term psychological impact of PDCD.