Intraoperative pain during cesarean delivery and impaired quality of recovery: a retrospective cohort study

Authors: Dr Darragh O'Reilly, Kaitlin Nelson MSc Dr Elise Hindle Sabina Dobrer P.Stat Dr Ilana Sebbag

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Slide 2 — Background and Aims

• Caesarean delivery (CD) is one of the most common surgical procedures worldwide

• Despite neuraxial anaesthesia being preferred, 11–22% of patients report intraoperative pain¹

• Physician assessment often underestimates pain² — patient-reported measures are essential

• ObsQoR-10 is a validated tool measuring patient-reported functional recovery after CD³

• Gap in the literature: The link between intraoperative pain and ObsQoR-10 at 24 hours post-CD is not yet understood

• Aim: Explore this relationship using patient-reported survey data.

References:

1. Anesthesiology. 2025;143(1)
    
2. Eur J Pain. 2022;26(1)
    
3. J Clin Anesth. 2020;63
    

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Slide 3 — Study Design and Methods

Design: Retrospective review of QA survey data following local REB approval

Setting: Tertiary teaching hospital QA initiative, launched November 2025

Data collection: ObsQoR-10 and intraoperative pain survey completed 24h postpartum via REDCap

Inclusion: Patients ≥19 years, caesarean delivery at ≥37 weeks' gestation

Exclusions: Substance use disorder, general anaesthesia as a primary technique, NICU admission/stillbirth, incomplete or duplicate responses

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Slide 4 — Results

Preliminary analysis for 35% (n=174) of our intended sample size (n=500) revealed an intraoperative pain incidence of 6.9% (n=12).

In patients with intraoperative pain, median ObsQoR-10 score was 67.5 [57.5–79.0]

In patients without intraoperative pain, median ObsQoR-10 score was 73.5 [65.0–85.0]

This difference was not statistically significant (p=0.196)

Higher parity was associated with increased risk of intraoperative pain (p=0.0005)

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Slide 5 — Discussion

• Intraoperative pain was associated with lower 24h ObsQoR-10 scores, but this did not reach statistical significance

• Higher parity may be an important predictor — women with parity ≥2 were more likely to report pain

Limitations:

• Low pain event rate limited statistical power
• Retrospective pain recall bias from survey design
• Higher intrathecal bupivacaine doses used locally (12.5–13.5 mg) vs other centres (9.5–12.5 mg) may limit generalisability

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Slide 6 — Conclusion

Key Takeaway Intraoperative pain may impair recovery after CD, but a larger, adequately powered study is needed to confirm this signal.

Clinical Implication Lower-than-expected pain rates at our centre may reflect higher intrathecal bupivacaine doses — a modifiable factor worth investigating.

Next Steps Complete recruitment to n=500 to achieve adequate power. Examine parity, anaesthesia technique, and individual ObsQoR-10 domain associations.