The Relationship Between Postoperative Pain and Subcutaneous Tissue Thickness Following Cesarean Section

Objective: The aim of this study is to identify clinical and obstetric factors associated with acute postoperative pain in pregnant women undergoing primary elective cesarean section and, in particular, to investigate the relationship between intraoperative subcutaneous tissue thickness and the severity of postoperative pain. Materials and Methods: This prospective cohort study included 82 pregnant women who underwent primary elective cesarean section between August 2025 and April 2026. All patients underwent cesarean delivery under spinal anesthesia by the same surgeon using a Pfannenstiel incision and received the clinic's standard postoperative analgesia protocol. Subcutaneous tissue thickness was measured along the Pfannenstiel incision line during cesarean section using a sterile millimeter ruler. Postoperative pain intensity was assessed using the Visual Analog Scale (VAS) at 0, 2, 6, 12, and 24 h. Relationships between variables were examined using Spearman's correlation analysis. Multivariate linear regression analyses were performed for the 12th- and 24th-hour VAS scores to evaluate the independent predictors of postoperative pain. Results: The participants' mean age was 26.1 ± 4.6 years, and their mean BMI was 30.4 ± 5.1 kg/m². The median subcutaneous tissue thickness was 20 mm (interquartile range (IQR): 15-25). No significant association was found between subcutaneous tissue thickness and postoperative pain scores or changes in hemoglobin levels (all p > 0.05). A moderate positive correlation was observed between subcutaneous tissue thickness and BMI (r = 0.501, p < 0.001) and fetal weight (r = 0.428, p < 0.001). In multivariate regression analyses, subcutaneous tissue thickness, age, BMI, fetal weight, gestational age, hemoglobin change, and parity were found not to be independent predictors of VAS scores at 12 or 24 h (all p > 0.05). Conclusions: Subcutaneous tissue thickness was not found to be associated with the severity of postoperative pain in patients undergoing primary elective cesarean section. Furthermore, none of the clinical and obstetric variables evaluated were shown to be independent predictors of acute postoperative pain. These findings suggest that local anatomical measurements alone may not be sufficient to explain postoperative pain following cesarean delivery and that postoperative pain is likely influenced by multiple non-anatomical factors.