Incidence of Pain during Cesarean Delivery with Neuraxial Anesthesia: An International, Prospective Cohort Study
Bibliographic record
Abstract
BACKGROUND: Neuraxial anesthesia techniques are considered the preferred techniques for cesarean delivery; however, the true incidence of pain during cesarean delivery with neuraxial anesthesia is not currently known. To date, studies have been retrospective or conducted in a single center. The primary aim of this international cohort study was to prospectively determine the incidence of patient-reported pain during cesarean delivery with neuraxial anesthesia. METHODS: Over 8 weeks, a multicenter cohort study was conducted in 15 centers across the United States and Canada. All patients who underwent cesarean delivery with neuraxial anesthesia were surveyed on postpartum day 1 regarding the presence of intraoperative pain and were asked to grade their pain using a numeric rating score (0 to 10) and rate their satisfaction (yes or no) with their pain management. RESULTS: A total of 3,693 patients were included in the analysis. An overall incidence of patient-reported pain during cesarean delivery was 7.6% (95% confidence interval [CI], 6.8 to 8.5%) with 282 of 3,693 patients reporting pain. In patients undergoing elective cesarean delivery, intraoperative pain was reported in 3.7% (95% CI, 2.7 to 5.0%) with spinal, 9.2% (95% CI, 6.7 to 12.2%) with combined spinal-epidural, and 12.2% (95% CI, 4.1 to 26.2%) with epidural top-up anesthesia. In the non-elective setting, pain was more commonly reported by patients: 5.7% (95% CI, 4.0 to 7.8%) with spinal, 7.1% (95% CI, 4.7 to 10.1%) with combined spinal-epidural, 8.0% (95% CI, 2.2 to 19.2%) with dural puncture epidural, and 13.2% (95% CI, 11.1 to 15.5%) with epidural top-up anesthesia. Patients who had intraoperative pain reported a median (interquartile range) numeric rating score of 6 (4 to 8) out of 10. In those who reported pain, dissatisfaction with how the pain was managed by the anesthesia team was reported by 29 (10.3%) patients. CONCLUSIONS: The overall incidence of patient-reported pain during cesarean delivery with neuraxial anesthesia in this multicenter cohort was 7.6%. This varied significantly by anesthesia technique, with spinal having the lowest incidence and epidural top-up having the highest. Further work is required to characterize the pain experience, understand its impact, and develop techniques to reduce its incidence.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".