Obstetric Anaesthesia Annual Scientific Meeting 2023

Preliminary findings from a post caesarean delivery pain core outcome set development study: time to shift our focus?

•Cesarean delivery is the most performed inpatient operation worldwide

•Adequate management of post caesarean delivery pain (PCDP) remains a challenge

•PCDP is associated with increased maternal persistent pain, postpartum depression, opioid use disorder, delays to recovery and impacts the ability to care for a newborn1

•The aim of this study is to produce a core outcome set for PCDP

•Study design: Scoping review and qualitative interviews

•Registration: PROSPERO, COMET; following PRISMA guidelines

•Source: 7 database search from May 2016 to 2021

•Inclusion criteria: Effectiveness RCTs for PCDP

•Outcomes: Identify outcome measures used to evaluate PCDP in published RCT and group according to previously published postpartum pain domains2

•Interviews: Focus group interviews with diverse participants from University College London Hospital operative delivery patient and public involvement group were conducted

•Scoping review: 101 RCTs

•375 inpatient and 17 outpatient outcomes

•The most reported outcome domains were:

1)Analgesia (n=242/375, 64.5%), analgesic consumption - most frequent

2)Pain intensity (n=120/375, 32%), VAS and the NRS - most frequent

3)Maternal and neonatal adverse effects (17.3% and 5.1%, respectively)

•Focus group discussions with patients (n=10):

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•PCDP was reported as a “huge” problem

•Little information about severity and persistence

•Major themes identified:

1)Psychological health

2)Impact on care of the newborn, and

3)Association of pain severity and lack of midwife support

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•By comparison, scoping review of inpatient studies revealed only 2% outcomes related to psychological health and 1% outcomes related to care of the newborn.

•Outcomes utilised in PCDP trials vary widely, and are pain intensity and analgesic-use focused

•Patient-centred, functionality-focused assessments could improve postpartum pain evaluation and treatment3

•Standardisation in outcomes is needed to promote research efficiency and identify optimal PCDP management4

Obstetric Anaesthesia Annual Scientific Meeting 2023

Preliminary findings from a post caesarean delivery pain core outcome set development study: is it time to shift our focus?

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