Charles Elinor A, Carter Hester, Stanford Susanna, Blake Lindsay, Eley Victoria, Carvalho Brendan, Sultan Pervez, Kua Justin, O'Carroll James E
.Specialty Trainee, Department of Anaesthesia and Perioperative Medicine, University College London Hospitals, London, UK.
Patient representative, Northumberland, UK.
Anesthesiology. 2025 Apr 4. doi: 10.1097/ALN.0000000000005486.
Neuraxial anesthesia is the gold standard technique for cesarean delivery, however pain during cesarean delivery may be underreported. The primary aim of this systematic review and meta-analysis was to determine the incidence of patient reported intraoperative pain during cesarean delivery under neuraxial anesthesia.
A literature search of databases (PubMed MEDLINE, Embase, Web of Science, Scopus, Cochrane Database of Systematic Reviews, and Central Register of Controlled Trials) was conducted. Search topics included terminology concerning cesarean delivery, neuraxial anesthesia, pain, and incidence. Meta-analyses were performed to calculate pooled incidences of patient reported pain and how mode of anesthesia influenced the incidence of patient reported pain, with included papers assessed for risk of bias.
A total of 2061 abstracts were screened; 34 articles were included (21 randomized studies and 13 non-randomized studies). The crude incidence of intraoperative pain under neuraxial anesthesia was 10.8% (1,229 out of 11,351 patients) and the pooled incidence was 17% (95%CI: 13% - 22%; 1,229 out of 11,351 patients). Patients who received spinal anesthesia had the lowest pooled incidence of pain of 14% (95%CI: 10.0% - 20.0%; 662 out of 8,002 patients) and those who received epidural top-up had the highest pooled incidence of pain of 33% (95%CI: 17.0% - 54.0%; 253 out of 1,395 patients). Risk of bias assessments showed high risk of bias in half of the included studies.
Patient reported pain during cesarean delivery under neuraxial anesthesia is common, with spinal and combined spinal-epidural anesthesia reporting a lower incidence of pain than epidural anesthesia. Intraoperative pain can have significant psychological impact for patients and medicolegal implications for providers. Further prospective studies are required to characterize and understand the impact of patient experiences of pain and develop techniques to reduce this complication.
椎管内麻醉是剖宫产的金标准技术，然而剖宫产术中的疼痛可能未得到充分报告。本系统评价和荟萃分析的主要目的是确定在椎管内麻醉下剖宫产患者报告的术中疼痛发生率。
对数据库（PubMed MEDLINE、Embase、Web of Science、Scopus、Cochrane系统评价数据库和对照试验中央注册库）进行文献检索。检索主题包括与剖宫产、椎管内麻醉、疼痛和发生率相关的术语。进行荟萃分析以计算患者报告疼痛的合并发生率，以及麻醉方式如何影响患者报告疼痛的发生率，并对纳入的论文进行偏倚风险评估。
共筛选了2061篇摘要；纳入34篇文章（21项随机研究和13项非随机研究）。椎管内麻醉下术中疼痛的粗发生率为10.8%（11351例患者中有1229例），合并发生率为17%（95%CI：13% - 22%；11351例患者中有1229例）。接受脊麻的患者疼痛合并发生率最低，为14%（95%CI：10.0% - 20.0%；8002例患者中有662例），接受硬膜外追加麻醉的患者疼痛合并发生率最高，为33%（95%CI：17.0% - 54.0%；1395例患者中有253例）。偏倚风险评估显示，纳入研究中有一半存在高偏倚风险。
椎管内麻醉下剖宫产患者报告的疼痛很常见，脊麻和腰麻-硬膜外联合麻醉的疼痛发生率低于硬膜外麻醉。术中疼痛会对患者产生重大心理影响，并对医疗提供者产生法医学影响。需要进一步的前瞻性研究来描述和了解患者疼痛体验的影响，并开发减少这种并发症的技术。
