Sangkum Lisa, Chalacheewa Theerawat, Tunprasit Choosak, Lavanrattanakul Phisut, Liu Henry
Department of Anesthesiology, Faculty of Medicine, Ramathibodi Hospital Mahidol University, Bangkok, 10400, Thailand.
Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA.
Curr Pain Headache Rep. 2024 Dec;28(12):1241-1248. doi: 10.1007/s11916-024-01301-y. Epub 2024 Jul 23.
Cesarean delivery is one of the most common surgical procedures performed worldwide. Approximately 28-78% of the patients have reported experiencing severe pain after Cesarean delivery, which is associated with adverse outcomes. Current analgesic management strategies employ a one-size-fits-all approach, which may not be suitable for all post-Cesarean patients. Our ongoing research and the purpose of this review are focusing on preoperative risk assessment to identify patients at risk of severe pain or needing higher doses of opioid or other analgesics.
Recent clinical investigations have found that by utilizing the demographic and psychological evaluations, screening tests, quantitative sensory testing, and assessment of response to local anesthetic infiltration, clinicians were potentially able to stratify the risks for severe post-cesarean pain. Several modalities demonstrated significant correlations with pain outcomes, although most of these correlations were weak to modest. Since consensus statement regarding predicting post-CD pain control are still lacking, these correlations can be clinically helpful. It is possible to identify patients at high risk of developing severe acute pain after cesarean section by preoperative demographic data, screening questionnaires, or other tools. Further studies are needed to identify additional variables or screening tools for more accurate prediction and investigate whether personalized analgesic regimens can lead to improved analgesic outcomes.
剖宫产是全球范围内最常见的外科手术之一。约28%-78%的患者报告称剖宫产术后经历了严重疼痛，这与不良后果相关。当前的镇痛管理策略采用一刀切的方法，可能并不适用于所有剖宫产术后患者。我们正在进行的研究以及本综述的目的聚焦于术前风险评估，以识别有严重疼痛风险或需要更高剂量阿片类药物或其他镇痛药的患者。
近期的临床研究发现，通过利用人口统计学和心理评估、筛查测试、定量感觉测试以及对局部麻醉浸润反应的评估，临床医生有可能对剖宫产术后严重疼痛的风险进行分层。几种方法显示出与疼痛结果有显著相关性，尽管其中大多数相关性较弱至中等。由于仍缺乏关于预测剖宫产术后疼痛控制的共识声明，这些相关性在临床上可能会有所帮助。通过术前人口统计学数据、筛查问卷或其他工具，可以识别出剖宫产术后发生严重急性疼痛的高风险患者。需要进一步研究以确定更多变量或筛查工具来进行更准确的预测，并研究个性化镇痛方案是否能改善镇痛效果。
