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The purpose of this prospective study was to assess chronic pain 3, and 12 months after cesarean delivery in a cohort of women in University hospital La Paz. We also aim to study the possible contribution of anesthetic and surgical risk factors for the development of Chronic post-surgical pain after cesarean (PCSCP)
Questions about age, race, gestational age, toxic habits, body mass index (BMI) (that was calculated from height and weight) previous vaginal delivery, cesarean delivery, other demographic, medical, surgical, and pre- operative pain variables were included.
-Were also recruited information about urgency level of caesarean using the classification proposed by Lucas et al.use of preoperative oxytocin, anesthesic technique before caesarean section (for example epidural for labor) and surgical and anesthesia variables.
Patients were visited within 24 h after surgery. Pain intensity was assessed as average pain at rest and on movement during the past 24 h using (NRS) and DN2 questionnaire. Also analgesic consumption and relevant side effects or complications were annotated.
Assessment after 3, and 12 months
-Patients were contacted by telephone by one of the authors at 3, and 12 months following cesarean section. This telephone interview usually takes no longer than 15 min. Chronic postsurgical pain (CPSP) was measured using the short form Brief Pain Inventory (BPI) BPI assesses the severity of pain and its impact on functioning. The pain severity items are presented as numeric rating scale (NRS). The patients were asked to rate their pain at rest and during movement in the previous week of the survey. Items of pain interference on function (general activity, mood, walking, work, relations with others, sleep and enjoyment of life ) are also presented as numeric rating scale (NRS) , are valued with 0 = does not interfere and 10 = interferes completely. There were also questions consumption of analgesics and neuropathic pains symptoms using Neuropathic pain (DN2) questionnaire.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Cesarean | Women hospitalized for cesarean section |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| CESAREAN | Procedure | Women hospitalized for cesarean section |
|
| Measure | Description | Time Frame |
|---|---|---|
| assess if clinically relevant pain measured by neuropathic pain questionnaire of 2 questions (DN2) > 3/10 one week after cesarean section(CS) was a risk factor for chronic post-surgical pain (CPSP) | Asses chronic pain 3 months after cesarean delivery in a cohort of women in University Hospital La Paz.A telephone interview with DN2 questionnaire was performed to all patients one week after surgery to assess the presence of neuropathic pain. CPSP diagnosis was retained in patients with the persistence of any symptom of pain or discomfort in the surgical site in the previous week, with an NRS score superior to 3/10 at rest and/or during movement 3 months after surgery. | three months |
| Measure | Description | Time Frame |
|---|---|---|
| assess whether a pain intensity superior to 5/10 on the NRS one week after Cesarean Section was related to a higher incidence of CPSP at three months. | Asses chronic pain 3 months after cesarean delivery in a cohort of women in University Hospital La Paz. A telephone interview with Numeric Rating Scale (NRS) questionnaire was performed to all patients one week after surgery to assess the presence of moderate pain. (No pain: NRS=0; Mild pain: NRS=1-3; Moderate pain: NRS= 4-6; Severe pain=7-10) CPSP diagnosis was retained in patients with the persistence of any symptom of pain or discomfort in the surgical site in the previous week, with an NRS score superior to 3/10 at rest and/or during movement 3 months after surgery. |
| Measure | Description | Time Frame |
|---|---|---|
| Asses if age of patients, measured as years, is a risk factor for chronic post surgical pain | Pain intensity was assessed as average pain at rest and on movement during the past 24 h using NRS and DN2 questionnaire 24 hours, one week and three months after surgery. | One week and three months. |
| Asses if gestational age of patients, measured as week of gestation, is a risk factor for chronic post surgical pain |
Inclusion Criteria:
Exclusion Criteria:
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Women hospitalized for cesarean section from March 2017 to September 2018 were recruited on the hospital on the day of surgery. Patients who agreed to participate and meet the inclusion criteria
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| Name | Affiliation | Role |
|---|---|---|
| Maria Cristina R ROCA, FEA | Hospital Universitario La Paz | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Hospital Universitario La Paz | Madrid | 28046 | Spain |
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| ID | Term |
|---|---|
| D010149 | Pain, Postoperative |
| ID | Term |
|---|---|
| D011183 | Postoperative Complications |
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D010146 | Pain |
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| Three months |
Pain intensity was assessed as average pain at rest and on movement during the past 24 h using NRS and DN2 questionnaire 24 hours, one week and three months after surgery. |
| One week and three months. |
| Asses if toxic habits of patients, measured as yes/no question: tobacco yes/no and drugs yes/no , is a risk factor for chronic post surgical pain | Pain intensity was assessed as average pain at rest and on movement during the past 24 h using NRS and DN2 questionnaire 24 hours, one week and three months after surgery. | One week and three months. |
| Asses if body mass index of patients, measured as kg/ m2, is a risk factor for chronic post surgical pain | Pain intensity was assessed as average pain at rest and on movement during the past 24 h using NRS and DN2 questionnaire 24 hours, one week and three months after surgery. | One week and three months. |
| Asses if previous vaginal delivery, measured as yes/no question: previous vaginal delivery yes/no, is a risk factor for chronic post surgical pain. | Pain intensity was assessed as average pain at rest and on movement during the past 24 h using NRS and DN2 questionnaire 24 hours, one week and three months after surgery. | One week and three months. |
| Asses if previous cesarean delivery, measured as yes/no question: previous cesarean delivery yes/no, is a risk factor for chronic post surgical pain. | Pain intensity was assessed as average pain at rest and on movement during the past 24 h using NRS and DN2 questionnaire 24 hours, one week and three months after surgery. | One week and three months. |
| Asses if previous chronic pelvic pain disorder, measured as a yes/no question: chronic pelvic pain disorder yes/no, is a risk factor for chronic post surgical pain | Pain intensity was assessed as average pain at rest and on movement during the past 24 h using NRS and DN2 questionnaire 24 hours, one week and three months after surgery. | One week and three months. |
| Asses if urgency level os cesarean, using classification proposed by lucas et al. is a risk factor for chronic post surgical pain | Classification relating the degree of urgency to the presence or absence of maternal or fetal compromise:
Pain intensity was assessed as average pain at rest and on movement during the past 24 h using NRS and DN2 questionnaire 24 hours, one week and three months after surgery. | One week and three months. |
| Asses if anesthetics technique before cesarean section (epidural for labour) information recruited as yes/no epidural for labour, is a risk factor for chronic post surgical pain | Pain intensity was assessed as average pain at rest and on movement during the past 24 h using NRS and DN2 questionnaire 24 hours, one week and three months after surgery. | One week and three months. |
| Asses if preoperative use of oxytocin during labour, information recruited as yes/no use of oxytocin during labour, is a risk factor for chronic post surgical pain. | Pain intensity was assessed as average pain at rest and on movement during the past 24 h using NRS and DN2 questionnaire 24 hours, one week and three months after surgery. | One week and three months. |
| Asses if kind of surgical incision: pfannenstiel or vertical is a risk factor for chronic post surgical pain. | Pain intensity was assessed as average pain at rest and on movement during the past 24 h using NRS and DN2 questionnaire 24 hours, one week and three months after surgery. | One week and three months. |
| Asses if closure of peritoneum: information recruited as yes/no question: closure of peritoneum yes/no, is a risk factor for chronic post surgical pain. is a risk factor for chronic post surgical pain. | Pain intensity was assessed as average pain at rest and on movement during the past 24 h using NRS and DN2 questionnaire 24 hours, one week and three months after surgery. | One week and three months. |
| Asses if closure uterine exteriorization: information recruited as yes/no question: uterine exteriorization yes/no, is a risk factor for chronic post surgical pain. is a risk factor for chronic post surgical pain. | Pain intensity was assessed as average pain at rest and on movement during the past 24 h using NRS and DN2 questionnaire 24 hours, one week and three months after surgery. | One week and three months. |
| Asses if duration of surgery (minutes) is a risk factor for chronic post surgical pain. is a risk factor for chronic post surgical pain. | Pain intensity was assessed as average pain at rest and on movement during the past 24 h using NRS and DN2 questionnaire 24 hours, one week and three months after surgery. | One week and three months. |
| Asses if anesthesia technique for cesarean section (general, epidural, combined or intradural) is a risk factor for chronic post surgical pain. | Pain intensity was assessed as average pain at rest and on movement during the past 24 h using NRS and DN2 questionnaire 24 hours, one week and three months after surgery. | One week and three months. |
| D009461 | Neurologic Manifestations |
| D012816 | Signs and Symptoms |