Racial and Ethnic Differences in Postpartum Pain and Opioid Consumption after Cesarean Delivery

Retrospective studies suggest that Black and Hispanic patients may experience greater postpartum pain and receive fewer analgesic medications after cesarean delivery compared with Asian and White patients. This study prospectively investigated racial and ethnic differences in postpartum pain and opioid consumption.

In this prospective, observational study conducted from 2018 to 2021, women scheduled for cesarean delivery completed validated psychological and pain questionnaires. On postoperative days (PODs) 0-2, nurses assessed pain (0-10) and administered opioid analgesics as needed. Average and maximal pain severity scores across PODs 0-2 were calculated. Administered opioid doses were converted to morphine milligram equivalents and normalized per hour (MME/hour) across PODs 0-2. Analyses of covariance examined racial and ethnic differences in postpartum pain and opioid consumption, controlling for maternal age, body mass index, preoperative pain severity, cesarean delivery type, and surgical duration.

Patients (N = 641) identified as African American (n = 67, 10.5%), Asian (n = 38, 5.9%), Hispanic/Latina (n = 64, 10%), and White (n = 472, 73.6%). No significant racial or ethnic differences were observed in preoperative psychological factors, including anxiety, depression, and pain catastrophizing. African American and Hispanic/Latina patients experienced greater postpartum pain and received higher opioid doses (MME/hour) than Asian and White patients.

Substantial variability in postpartum pain was observed within each racial and ethnic group, highlighting the importance of factors beyond race and ethnicity that may modulate pain. Given the lack of significant differences in psychological factors assessed, future research should investigate additional psychosocial factors (e.g., experiences of discrimination) and resilience factors (e.g., optimism) that may help identify targets for intervention.