From the *Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA; and †Department of Anesthesiology, Maternity Hospital Santa Joana, São Paulo, Brazil.
Reg Anesth Pain Med. 2014 Nov-Dec;39(6):478-86. doi: 10.1097/AAP.0000000000000158.
The incidence of chronic pain after cesarean delivery (CD) has been estimated to range between 0.3% and 18%. This wide range may be explained by differing study methodologies. Furthermore, a comprehensive characterization of pain quality is lacking. The aim of this study was to evaluate persistent pain in a healthy obstetric population undergoing planned CD and to provide a comprehensive description of pain quality.
Three hundred eighty-one women with no pain history undergoing CD were included in this prospective, observational cohort study. Spinal anesthesia was standardized, and postoperative pain was recorded at 24 hours. In each woman, pain was assessed at 8 weeks, and 6 and 12 months using questionnaires of pain intensity and interference. Pain quality was assessed using the Short-Form McGill Pain Questionnaire-Revised.
The incidence of persistent pain at 8 weeks was 11% (95% confidence interval, 8%-14%), with pain reported as being mild and interfering with common daily activities by 32% of women. At 6 and 12 months, the incidence was 3% (95% confidence interval, 2%-6%) and 0.6% (95% confidence interval, 0%-2%) respectively, with pain rarely interfering with daily activities. However, 22% of women described other surgery-related symptoms at 12 months.
The incidence of chronic pain at 12 months after planned CD is low (0.6%) and if present symptoms are mostly mild and not interfering with common daily activities. Using Short-Form McGill Pain Questionnaire-Revised, this study provides a comprehensive evaluation of pain quality that can be used as a basis in future post-CD pain trials.
剖宫产术后慢性疼痛(cesarean delivery,CD)的发生率估计在 0.3%至 18%之间。这种较大的范围可能是由于研究方法的不同所致。此外,对疼痛质量的全面描述还很缺乏。本研究旨在评估行计划性剖宫产的健康产妇人群中持续性疼痛的发生情况,并对疼痛质量进行全面描述。
本前瞻性观察性队列研究纳入了 381 例无疼痛史的行剖宫产的妇女。采用标准的脊麻,术后 24 小时记录疼痛情况。在每位女性中,在 8 周、6 个月和 12 个月时使用疼痛强度和干扰问卷评估疼痛。使用简化的麦吉尔疼痛问卷修订版评估疼痛质量。
8 周时持续性疼痛的发生率为 11%(95%置信区间,8%-14%),32%的女性报告疼痛为轻度,并干扰了日常活动。在 6 个月和 12 个月时,发生率分别为 3%(95%置信区间,2%-6%)和 0.6%(95%置信区间,0%-2%),疼痛很少干扰日常活动。然而,22%的女性在 12 个月时描述了其他与手术相关的症状。
计划性剖宫产术后 12 个月慢性疼痛的发生率较低(0.6%),如果存在症状,大多为轻度,且不干扰日常活动。使用简化的麦吉尔疼痛问卷修订版,本研究对疼痛质量进行了全面评估,可作为未来剖宫产术后疼痛试验的基础。