Limits...
Intrathecal Administration of Morphine Decreases Persistent Pain after Cesarean Section: A Prospective Observational Study.

Moriyama K, Ohashi Y, Motoyasu A, Ando T, Moriyama K, Yorozu T - PLoS ONE (2016)

Bottom Line: Multivariate analyses identified lighter weight (p = 0.011) and non-intrathecal administration of morphine (p = 0.023) as determinant factors associated with persistent pain at 3 months.The adjusted odds ratio of intrathecal administration of morphine to reduce persistent pain was 0.424, suggesting that intrathecal administration of morphine could decrease chronic pain by 50%.Although no effect on acute pain was observed, intrathecal administration of morphine significantly decreased chronic pain after CS.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesiology, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-8611, Japan.

ABSTRACT

Purpose: Chronic pain after cesarean section (CS) is a serious concern, as it can result in functional disability. We evaluated the prevalence of chronic pain after CS prospectively at a single institution in Japan. We also analyzed perioperative risk factors associated with chronic pain using logistic regression analyses with a backward-stepwise procedure.

Materials and methods: Patients who underwent elective or emergency CS between May 2012 and May 2014 were recruited. Maternal demographics as well as details of surgery and anesthesia were recorded. An anesthesiologist visited the patients on postoperative day (POD) 1 and 2, and assessed their pain with the Prince Henry Pain Scale. To evaluate the prevalence of chronic pain, we contacted patients by sending a questionnaire 3 months post-CS.

Results: Among 225 patients who questionnaires, 69 (30.7%) of patients complained of persistent pain, although no patient required pain medication. Multivariate analyses identified lighter weight (p = 0.011) and non-intrathecal administration of morphine (p = 0.023) as determinant factors associated with persistent pain at 3 months. The adjusted odds ratio of intrathecal administration of morphine to reduce persistent pain was 0.424, suggesting that intrathecal administration of morphine could decrease chronic pain by 50%. In addition, 51.6% of patients had abnormal wound sensation, suggesting the development of neuropathic pain. Also, 6% of patients with abnormal wound sensation required medication, yet no patients with persistent pain required medication.

Conclusion: Although no effect on acute pain was observed, intrathecal administration of morphine significantly decreased chronic pain after CS.

No MeSH data available.


Related in: MedlinePlus

(A) Pain severity on postoperative day (POD) 1 and 2 of cesarean delivery as assessed by the Prince Henry Pain Scale. Pain severity was assessed by anesthesiologists who visited the patient, and was recorded with the PHPS: 1, no pain upon coughing; 2, pain upon coughing or movement but not on deep breathing; 3, pain on deep breathing but not at rest; 4, slight pain at rest; 5, severe pain at rest. *Indicates significantly lower PHPS score on POD2 compared with the PHPS score on POD1 by Wilcoxon rank sum tests (p < 0.001). (B) Pain severity on POD1 in patients with and without chronic pain 3 months after cesarean delivery. Pain severity on POD1 assessed by the PHPS was compared in patients with or without chronic pain 3 months after cesarean delivery. No significant difference was detected by Wilcoxon rank sum tests (p = 0.294).
© Copyright Policy
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4862627&req=5

pone.0155114.g001: (A) Pain severity on postoperative day (POD) 1 and 2 of cesarean delivery as assessed by the Prince Henry Pain Scale. Pain severity was assessed by anesthesiologists who visited the patient, and was recorded with the PHPS: 1, no pain upon coughing; 2, pain upon coughing or movement but not on deep breathing; 3, pain on deep breathing but not at rest; 4, slight pain at rest; 5, severe pain at rest. *Indicates significantly lower PHPS score on POD2 compared with the PHPS score on POD1 by Wilcoxon rank sum tests (p < 0.001). (B) Pain severity on POD1 in patients with and without chronic pain 3 months after cesarean delivery. Pain severity on POD1 assessed by the PHPS was compared in patients with or without chronic pain 3 months after cesarean delivery. No significant difference was detected by Wilcoxon rank sum tests (p = 0.294).

Mentions: Pain severity on POD1 and 2 is shown in Fig 1A. Median values of the PHPS were 1 on both POD1 and 2. On POD2, it decreased significantly from that on POD1 (p<0.001). We compared pain severity on POD1 among patients with or without persistent pain 3 months after delivery (Fig 1B). Although the median value of the PHPS on POD1 was 2 in patients with persistent pain, there was no significant difference (p = 0.294).


Intrathecal Administration of Morphine Decreases Persistent Pain after Cesarean Section: A Prospective Observational Study.

Moriyama K, Ohashi Y, Motoyasu A, Ando T, Moriyama K, Yorozu T - PLoS ONE (2016)

(A) Pain severity on postoperative day (POD) 1 and 2 of cesarean delivery as assessed by the Prince Henry Pain Scale. Pain severity was assessed by anesthesiologists who visited the patient, and was recorded with the PHPS: 1, no pain upon coughing; 2, pain upon coughing or movement but not on deep breathing; 3, pain on deep breathing but not at rest; 4, slight pain at rest; 5, severe pain at rest. *Indicates significantly lower PHPS score on POD2 compared with the PHPS score on POD1 by Wilcoxon rank sum tests (p < 0.001). (B) Pain severity on POD1 in patients with and without chronic pain 3 months after cesarean delivery. Pain severity on POD1 assessed by the PHPS was compared in patients with or without chronic pain 3 months after cesarean delivery. No significant difference was detected by Wilcoxon rank sum tests (p = 0.294).
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4862627&req=5

pone.0155114.g001: (A) Pain severity on postoperative day (POD) 1 and 2 of cesarean delivery as assessed by the Prince Henry Pain Scale. Pain severity was assessed by anesthesiologists who visited the patient, and was recorded with the PHPS: 1, no pain upon coughing; 2, pain upon coughing or movement but not on deep breathing; 3, pain on deep breathing but not at rest; 4, slight pain at rest; 5, severe pain at rest. *Indicates significantly lower PHPS score on POD2 compared with the PHPS score on POD1 by Wilcoxon rank sum tests (p < 0.001). (B) Pain severity on POD1 in patients with and without chronic pain 3 months after cesarean delivery. Pain severity on POD1 assessed by the PHPS was compared in patients with or without chronic pain 3 months after cesarean delivery. No significant difference was detected by Wilcoxon rank sum tests (p = 0.294).
Mentions: Pain severity on POD1 and 2 is shown in Fig 1A. Median values of the PHPS were 1 on both POD1 and 2. On POD2, it decreased significantly from that on POD1 (p<0.001). We compared pain severity on POD1 among patients with or without persistent pain 3 months after delivery (Fig 1B). Although the median value of the PHPS on POD1 was 2 in patients with persistent pain, there was no significant difference (p = 0.294).

Bottom Line: Multivariate analyses identified lighter weight (p = 0.011) and non-intrathecal administration of morphine (p = 0.023) as determinant factors associated with persistent pain at 3 months.The adjusted odds ratio of intrathecal administration of morphine to reduce persistent pain was 0.424, suggesting that intrathecal administration of morphine could decrease chronic pain by 50%.Although no effect on acute pain was observed, intrathecal administration of morphine significantly decreased chronic pain after CS.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesiology, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-8611, Japan.

ABSTRACT

Purpose: Chronic pain after cesarean section (CS) is a serious concern, as it can result in functional disability. We evaluated the prevalence of chronic pain after CS prospectively at a single institution in Japan. We also analyzed perioperative risk factors associated with chronic pain using logistic regression analyses with a backward-stepwise procedure.

Materials and methods: Patients who underwent elective or emergency CS between May 2012 and May 2014 were recruited. Maternal demographics as well as details of surgery and anesthesia were recorded. An anesthesiologist visited the patients on postoperative day (POD) 1 and 2, and assessed their pain with the Prince Henry Pain Scale. To evaluate the prevalence of chronic pain, we contacted patients by sending a questionnaire 3 months post-CS.

Results: Among 225 patients who questionnaires, 69 (30.7%) of patients complained of persistent pain, although no patient required pain medication. Multivariate analyses identified lighter weight (p = 0.011) and non-intrathecal administration of morphine (p = 0.023) as determinant factors associated with persistent pain at 3 months. The adjusted odds ratio of intrathecal administration of morphine to reduce persistent pain was 0.424, suggesting that intrathecal administration of morphine could decrease chronic pain by 50%. In addition, 51.6% of patients had abnormal wound sensation, suggesting the development of neuropathic pain. Also, 6% of patients with abnormal wound sensation required medication, yet no patients with persistent pain required medication.

Conclusion: Although no effect on acute pain was observed, intrathecal administration of morphine significantly decreased chronic pain after CS.

No MeSH data available.


Related in: MedlinePlus