Results on the BPI showed relatively low scores (2-5 points on a 10-point scale) for pain – at rest, while sitting, and specifically for uterine cramping – at 12 hours and at 24 hours postoperatively, with no significant differences between the primary and repeat cesarean groups, reported Dr. Landau, who is professor and director of obstetric anesthesiology and clinical genetics, anesthesiology, and pain medicine at the University of Washington Medical Center.
At 48 hours, there was a trend whereby women undergoing repeat cesarean had a higher level of pain while at rest relative to women undergoing primary cesarean, but pain while sitting, uterine cramping, wound hyperalgesia, and opioid use were essentially the same.
There also were no significant differences between the primary and repeat cesarean groups with respect to average pain in the past week, worst pain in the past week, and pain now, at either 8 weeks or at 6 months postoperatively.
"In this cohort of healthy women undergoing an elective cesarean delivery under what is considered the best modality to have good intraoperative anesthesia and postoperative analgesia, we did not find a relevant difference in pain scores or analgesic use in the first 48 hours. Therefore, I cannot recommend we should change our practice in giving everybody the same thing," said Dr. Landau.
"I would however caution that we shouldn’t yet extrapolate these results to other clinical contexts, in particular, women who have high risk for pain, prior pain, a nonelective primary cesarean delivery, or women [operated on] with different surgical techniques," she added. "And I would propose ... that we do look into scar hyperalgesia in those who have had a previous cesarean delivery, in trying to tease out women who are potentially at risk for more severe pain postoperatively."
Session moderator Dr. Dennis C. Shay in a group anesthesia practice in San Diego asked, "Did you look at activity levels? I would imagine with a repeat C-section, they have a young child, so if the child is visiting, maybe they are getting up and walking around a lot more than if it was just their first child. And maybe that would make a difference."
It would be challenging to interpret how activity data relate to pain data, Dr. Landau replied. For example, women could be less active because they have more pain or because they are more comfortable.
Dr. Ortner and Dr. Landau said they had no relevant financial conflicts of interest.