215 posters, 5 topics, 22 sessions, 596 authors, 283 institutions

Obstetric Anaesthesia Annual Scientific Meeting 2025

May 15 - 16, 2025 | ICC, 2 Lanyon Place, Belfast BT1 3WH

6779441

Investigating analgesia adequacy and intraoperative pain during caesarean delivery: single-centre pilot and feasibility study

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Poster Presenter

Craig Robert

Authors

Reshma Patel, Robert Craig, Ning Lynn Chen, Samantha Hill, Susanna Stanford, Ramani Moonesinghe, James O'Carroll

Affiliations

University College London Hospital, Department of Anaesthesia and Perioperative Medicine, University College London Hospital, London, UK, Patient Representative, UK, National Institute for Health Research Central London Patient Safety Research Collaboration, UCL Hospitals, London, UK.

Part of Topic

Original Research

Introduction

•The incidence and sequelae of intraoperative pain during caesarean delivery (CD) varies widely and depends on patient, clinician, anaesthetic, obstetric, and institutional level factors.

•Published data on the incidence of pain during CD are predominantly from single centre retrospective studies, with incidence rates ranging from 1.7%(1) to 19.7%(2), with evidence from a systematic review putting the figure at 14.6%(3).

•Patient reported outcome measures are the gold standard for measuring postpartum recovery, but no such data exists for CD.

•This study aims to establish the incidence, risk factors and sequalae of pain during CD under neuraxial anaesthesia (NA); and to use patient reported outcome measures to evaluate the physical and psychological impact on those who experienced intraoperative pain.

Methods

•This is a prospective, single centre observational cohort study conducted at a tertiary teaching hospital. It will assess the feasibility of a planned multicentre national study and present descriptive and outcome data from the pilot cohort.

•Ethical approval was granted by the UK National Research Ethics Service (REC 24/EM/0084).

•Inclusion criteria: Scheduled or unscheduled CD, >17 years old, gestational age >31 weeks, neuraxial anaesthesia as primary mode of anaesthesia

•Exclusion criteria: Patient refusal, general anaesthesia as planned mode of delivery, neonatal or fetal demise.

Delivery

•- Demographic and perioperative data collected from all patients having CD for 26 days in July 2024

18-30 hours

•- Consenting patients completed questionnaires about their intra- and post-operative experience

6 weeks +/- 3 days

•- Consenting patients completed screening tools for anxiety, depression and Post-Traumatic Stress Disorder (PTSD)

Results

Clinician reported pain

•15 out of 156 patients (9.6%)

•9 patients had intra-operative pain requiring unplanned analgesia

•3 patients converted to general anaesthetic before knife to skin

•3 patients had NA repeated before knife to skin for inadequate block

Patient recruitement

•156 patients included

•118 patients consented

•100 patients provided data at 18-30 hour mark

•80 patients provided data at 6 week mark

Discussion

•The incidence of patient-reported inadequate analgesia was higher than clinician reported neuraxial inadequacy (19% vs. 9%).

•Only 5% of patients who did not strongly agree that they had sufficient analgesia in the operating room were documented as having pain by their anaesthetist.

•This suggests a difference to what clinicians and patients perceive as intra-operative pain as well as a communication barrier between the two groups

•The study was feasible, had high consent and follow-up rates, and supports delivery of an international multicentre study.

References

1.Lee S, Lew E, Lim Y, Sia AT. Failure of augmentation of labor epidural analgesia for intrapartum cesarean delivery: a retrospective review. Anesth Analg. 2009;108(1):252-254. doi:10.1213/ane.0b013e3181900260

2.Pan PH, Bogard TD, Owen MD. Incidence and characteristics of failures in obstetric neuraxial analgesia and anesthesia: a retrospective analysis of 19,259 deliveries. Int J Obstet Anesth. 2004;13(4):227-233. doi:10.1016/j.ijoa.2004.04.008

3.Patel R, Kua J, Sharawi N, et al. Inadequate neuraxial anaesthesia in patients undergoing elective caesarean section: a systematic review. Anaesthesia. 2022;77(5):598-604. doi:10.1111/anae.15657