Related Experiment Video
Updated: Aug 5, 2026
An Experimental Paradigm for the Prediction of Post-Operative Pain (PPOP)
Published on: January 27, 2010
Effect of preoperative anxiety on acute post-spinal low back pain after cesarean delivery: a prospective cohort study
Susmita Shrestha1, Asish Subedi2, Krishna Pokharel1
1Department of Anesthesiology & Critical Care Medicine, BP Koirala Institute of Health Sciences, Dharan, Nepal.
Purpose:
While multiple factors contribute to acute post-spinal low back pain (LBP), the role of preoperative anxiety in obstetric patients remains unclear. This prospective study investigated the association between preoperative anxiety and acute post-spinal LBP following cesarean delivery (CD).
Methods:
Patients undergoing elective (category 4) or non-elective (categories 2 and 3) CD under spinal anesthesia were enrolled. Preoperative anxiety was defined as an Amsterdam Preoperative Anxiety and Information Scale score ≥ 11. The primary outcome was the incidence of acute post-spinal LBP during movement at 24 h after surgery. Based on LBP scores, patients were categorized into no-to-mild pain (Numeric Rating Scale [NRS] 0-3) and moderate-to-severe pain (NRS ≥ 4). Logistic regression was used to identify risk factors for the incidence and presence of moderate-to-severe acute post-spinal LBP.
Results:
Among 295 patients analyzed, 78 (26%) had preoperative anxiety. Acute post-spinal LBP during movement at 24 h occurred in 42 patients (14%). Pre-existing LBP (odds ratio [OR] 3.37, 95% confidence interval [CI] 1.61-7.06; P = 0.001) and delayed post-delivery ambulation (OR 1.26, 95% CI 1.09-1.46; P = 0.002) were associated with the overall incidence of acute post-spinal LBP. Predictors of moderate-to-severe pain were preexisting LBP (OR 3.88, 95% CI 1.33-11.28; P = 0.013), preoperative anxiety (OR 3.50, 95% CI 1.24-9.84; P = 0.017), and delayed post-delivery ambulation (OR 1.47, 95% CI 1.17-1.85; P = 0.001).
Conclusion:
Preoperative anxiety was not associated with the incidence of acute post-spinal LBP but independently predicted moderate-to-severe pain. Pre-existing LBP and delayed post-delivery ambulation were also independent predictors of moderate-to-severe acute post-spinal LBP.
