title: Chronic pain after cesarean section. Influence of anesthetic/surgical technique and postoperative analgesia.
abstract: OBJECTIVE
  Brazil ranks second among countries with the highest rates of cesarean section in the world. Little is known about the future consequences of this procedure on maternal health. This study investigated the influence of anesthetic/surgical technique and postoperative analgesia on the onset of chronic pain after three months of cesarean section.
  
  
  METHODS
  This is a prospective randomized study of 443 patients undergoing cesarean section (elective and emergency), with different doses of hyperbaric bupivacaine 0.5% and opioids in spinal anesthesia. Patients were alocated into five groups as follow: G1 received hyperbaric bupivacaine (8 mg), sufentanil (2.5 μg), and morphine (100 μg); G2 received hyperbaric bupivacaine (10 mg), sufentanil (2.5 μg), and morphine (100 μg); G3 received hyperbaric bupivacaine (12.5 mg) and morphine (100 μg); G4 received hyperbaric bupivacaine (15 mg) and morphine (100 μg); G5 received hyperbaric bupivacaine (12.5 mg) and morphine (100 μg), without perioperative anti-inflammatory. Pain at rest and in movement were evaluated in the immediate postoperative period. Phone contact was made after three months of surgery for identification of patients with chronic pain.
  
  
  RESULTS
  The incidence of chronic pain in the groups was G1=20%; G2=13%; G3=7.1%; G4=2.2%, and G5=20.3%. Patients who reported higher pain scores in the postoperative period had a higher incidence of chronic pain (p<0.05).
  
  
  CONCLUSIONS
  The incidence of chronic pain decreases with higher doses of local anesthetics and use of anti-inflammatory drugs. The higher pain scores in the postoperative period were associated with chronic pain development after three months of cesarean section.
authors.affiliation: Faculdade de Medicina, Universidade de São Paulo, (USP), Brazil. thaiscancado@terra.com.br
authors.forename: Thais Orrico
authors.initials: TO
authors.lastname: de Brito Cançado
authors.forename: Maruan
authors.initials: M
authors.lastname: Omais
authors.forename: Hazem Adel
authors.initials: HA
authors.lastname: Ashmawi
authors.forename: Marcelo Luis Abramides
authors.initials: ML
authors.lastname: Torres
mesh_terms: D000328:Adult; D016362:Analgesia, Obstetrical; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D000773:Anesthesia, Obstetrical; D000779:Anesthetics, Local / Q000008:administration & dosage*; D002585:Cesarean Section / Q000009:adverse effects* / Q000379:methods; D059350:Chronic Pain / Q000209:etiology*; D005260:Female; D006801:Humans; D010149:Postoperative Pain / Q000628:therapy*; D011247:Pregnancy; D011446:Prospective Studies
chemical_list: D000701:Analgesics, Opioid; D000779:Anesthetics, Local