Incidence of Pain during Cesarean Delivery with Neuraxial Anesthesia: An International, Prospective Cohort Study

Neuraxial anesthesia techniques are considered the preferred techniques for cesarean delivery; however, the true incidence of pain during cesarean delivery with neuraxial anesthesia is not currently known. To date, studies have been retrospective or conducted in a single center. The primary aim of this international cohort study was to prospectively determine the incidence of patient-reported pain during cesarean delivery with neuraxial anesthesia.

Over 8 weeks, a multicenter cohort study was conducted in 15 centers across the United States and Canada. All patients who underwent cesarean delivery with neuraxial anesthesia were surveyed on postpartum day 1 regarding the presence of intraoperative pain and were asked to grade their pain using a numeric rating score (0 to 10) and rate their satisfaction (yes or no) with their pain management.

A total of 3,693 patients were included in the analysis. An overall incidence of patient-reported pain during cesarean delivery was 7.6% (95% confidence interval [CI], 6.8 to 8.5%) with 282 of 3,693 patients reporting pain. In patients undergoing elective cesarean delivery, intraoperative pain was reported in 3.7% (95% CI, 2.7 to 5.0%) with spinal, 9.2% (95% CI, 6.7 to 12.2%) with combined spinal-epidural, and 12.2% (95% CI, 4.1 to 26.2%) with epidural top-up anesthesia. In the non-elective setting, pain was more commonly reported by patients: 5.7% (95% CI, 4.0 to 7.8%) with spinal, 7.1% (95% CI, 4.7 to 10.1%) with combined spinal-epidural, 8.0% (95% CI, 2.2 to 19.2%) with dural puncture epidural, and 13.2% (95% CI, 11.1 to 15.5%) with epidural top-up anesthesia. Patients who had intraoperative pain reported a median (interquartile range) numeric rating score of 6 (4 to 8) out of 10. In those who reported pain, dissatisfaction with how the pain was managed by the anesthesia team was reported by 29 (10.3%) patients.

The overall incidence of patient-reported pain during cesarean delivery with neuraxial anesthesia in this multicenter cohort was 7.6%. This varied significantly by anesthesia technique, with spinal having the lowest incidence and epidural top-up having the highest. Further work is required to characterize the pain experience, understand its impact, and develop techniques to reduce its incidence.