Pain Assessment after Cesarean Section with a Standardized Pain Questionnaire

Background: The importance of postoperative pain management after Cesarean Section (CS) becomes clear in view of the increasing CS rates and the negative long-term consequences of inadequate acute pain therapy. The aim of this study was to describe postoperative pain after CS, to assess patient satisfaction with postoperative pain management and to identify reasons associated with stronger postoperative pain. Methods: Assessment of postoperative pain took place on the first postoperative day after CS using the PAIN OUT Outcome and Process Questionnaire. To cover a wide range of risk factors, information regarding demography, intervention, anesthesia and pain therapy as well as relevant obstetric parameters were recorded. These factors were analyzed for correlation with postoperative pain. Results: Overall maximum pain intensity was high (7.3±1.6) but only short-lasting. Adequate pain management relieved pain by 70% (minimal pain intensity 2.1±1.6) and resulted in a good patient satisfaction in 70%. Severe postoperative pain was significantly associated with greater impairment in activity and uncertainty (p <0.01, r = 0.46). A weak correlation was found between maternal age and intensity of postsurgical pain (Pearson coefficient: 0.29, p=0.021) with women ≥35 years having stronger pain. Intensity of postsurgical pain was rated statistically significant lower by nulliparous women (6.9±1.5) compared with parity ≥1 women (7.7±1.7) (p=0.04). Conclusion: Risk factors for higher pain intensity after CS were maternal age ≥35 years and parity ≥1. Therefore, a sufficient and individual pain management especially in these women is mandatory.