Pain after cesarean section: do we have reliable predictors? Scoping review

Abstract

BACKGROUND: Every year, the number of publications devoted to the study of various tools for predicting the intensity of pain after cesarean section is growing, which necessitated the generalization and systematization of these data. OBJECTIVE: Our aim was to identify factors contributing to high-intensity pain after cesarean section (CS). MATERIALS AND METHODS: a scoping review based on the PRISMA for Scoping Reviews (PRISMA-ScR) guidelines was conducted using PubMed, Cochrane Database of Systematic Reviews, and Google Scholar. The search was performed using the following keywords: “predictors” OR “prediction” OR “forecasting” AND “cesarean section” AND “pain”) in Russian and English, last search date November 30, 2022. The inclusion criteria for the review were formulated using the PICOD method: (P) population: postpartum women; (I) intervention: CS surgery; (C) comparison: surgical approach, anesthesia method, psychological status, pain threshold, genetic characteristics; (O) outcomes: pain intensity scores, analgesic requirements; (D) study design: prospective/retrospective cohort studies. Exclusion criteria were as follows: lack of sufficient data or outcome of interest; duplicate publication; chronic pain; publications devoted to pain relief during childbirth or pain after other surgical interventions; lack of full-text version; reviews and meta-analyses. The quality of selected non-randomized cohort studies was assessed using the Newcastle-Ottawa Scale (NOS). RESULTS: 30 cohort studies were selected, involving 11,063 patients. Most studies were assigned an NOS score of 6 to 8, which was considered good quality. Two groups of factors were identified as predictors of the intensity of postoperative pain: factors associated with the characteristics of the patient (physical status, psychological status, individual pain threshold and pain tolerance, genetic characteristics) and factors associated with the characteristics of the operation and anesthesia. CONCLUSION: the scoping review allowed us to identify reliable factors predicting high-intensity pain after CS, which should be taken into account when planning anesthesiological care for patients.