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 distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 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 teacher head, 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".