The influence of preoperative epidural labor analgesia on postoperative pain in parturients undergoing emergency cesarean section A retrospective analysis

Abstract

Background Intense noxious input from the periphery may result in central sensitization and hyperexcitability, thus accentuating subsequent postoperative pain. Parturients who undergo emergency cesarean section (C-sec) after experiencing labor pain often develop labor pain-induced sensitization. Objective This retrospective study evaluated whether parturients without epidural labor analgesia (ELA) who underwent emergency C-sec, experienced more severe postoperative pain and required more rescue analgesics during the postoperative period. Methods The institution's medical database was searched for parturients who underwent emergency C-sec under spinal anesthesia for any reason between January 2013 and December 2016. Those who underwent elective C-sec under spinal anesthesia were included as the reference arm. Parturients were divided into three groups: ELA, no-ELA and elective. Characteristics of patients and perioperative outcomes were evaluated. As primary outcomes, numerical rating scale (NRS) for postoperative pain (0-10) was recorded up to 96 & x202f;h postoperatively, and use of rescue analgesics was evaluated at 6, 24, and 48 & x202f;h postoperatively. Results In the ELA, no-ELA, and elective groups, 61, 73, and 88 parturients, respectively, were ultimately enrolled. The NRS for pain were similar among the three groups, except at 6 & x202f;h postoperatively. Parturients in the no-ELA group demonstrated significantly higher NRS at 6 & x202f;h postoperatively than those in the ELA group (P & x202f;= 0.01).More patients in the no-ELA group required rescue analgesics than in the ELA (P & x202f;= 0.001) and elective groups (P & x202f;< 0.001) at 6-24 & x202f;h postoperatively. Moreover, the proportion of patients requiring rescue analgesics >= 2 times was also significantly higher in the no-ELA group (vs. the ELA group, P & x202f;= 0.004; vs. the elective group, P & x202f;< 0.001). Conclusion Parturients undergoing emergency C-sec without ELA management during labor experienced greater postoperative pain and a greater use of rescue analgesics during the postoperative period. The findings suggest that administration of ELA before emergency C-sec may act as pre-emptive analgesia against postoperative pain.