title: Quality of pain treatment after caesarean section: Results of a multicentre cohort study.
abstract: BACKGROUND
  A large cohort study recently reported high pain scores after caesarean section (CS). The aim of this study was to analyse how pain after CS interferes with patients' activities and to identify possible causes of insufficient pain treatment.
  
  
  METHODS
  We analysed pain scores, pain-related interferences (with movement, deep breathing, mood and sleep), analgesic techniques, analgesic consumption, adverse effects and the wish to have received more analgesics during the first 24 h after surgery. To better evaluate the severity of impairment by pain, the results of CS patients were compared with those of patients undergoing hysterectomy.
  
  
  RESULTS
  CS patients (n = 811) were compared with patients undergoing abdominal, laparoscopic-assisted vaginal or vaginal hysterectomy (n = 2406, from 54 hospitals). Pain intensity, wish for more analgesics and most interference outcomes were significantly worse after CS compared with hysterectomies. CS patients with spinal or general anaesthesia and without patient-controlled analgesia (PCA) received significantly less opioids on the ward (62% without any opioid) compared with patients with PCA (p < 0.001). Patients with PCA reported pain-related interference with movement and deep breathing between 49% and 52% compared with patients without PCA (between 68% and 73%; p-values between 0.004 and 0.013; not statistically significant after correction for multiple testing).
  
  
  CONCLUSIONS
  In daily clinical practice, pain after CS is much higher than previously thought. Pain management was insufficient compared with patients undergoing hysterectomy. Unfavourable outcome was mainly associated with low opioid administration after CS. Contradictory pain treatment guidelines for patients undergoing CS and for breastfeeding mothers might contribute to reluctance of opioid administration in CS patients.
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, University of Cologne, Germany.
authors.forename: H
authors.initials: H
authors.lastname: Marcus
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, University Medical Centre Utrecht, The Netherlands.
authors.forename: H J
authors.initials: HJ
authors.lastname: Gerbershagen
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, University Medical Centre Utrecht, The Netherlands.|Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, The Netherlands.
authors.forename: L M
authors.initials: LM
authors.lastname: Peelen
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, University of Cologne, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Aduckathil
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, University Medical Centre Utrecht, The Netherlands.
authors.forename: T H
authors.initials: TH
authors.lastname: Kappen
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, University Medical Centre Utrecht, The Netherlands.
authors.forename: C J
authors.initials: CJ
authors.lastname: Kalkman
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, Jena University Hospital, Germany.
authors.forename: W
authors.initials: W
authors.lastname: Meissner
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, University of Bern, Switzerland.|Department of Anaesthesiology and Pain Medicine, Inselspital, University of Bern, Switzerland.|Department of Clinical Research, University of Bern, Switzerland.
authors.forename: U M
authors.initials: UM
authors.lastname: Stamer
mesh_terms: D000328:Adult; D016058:Analgesia, Patient-Controlled; D000700:Analgesics / Q000009:adverse effects / Q000627:therapeutic use; D000773:Anesthesia, Obstetrical; D002585:Cesarean Section; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007044:Hysterectomy; D059408:Pain Management; D010147:Pain Measurement; D010149:Postoperative Pain / Q000628:therapy*; D011247:Pregnancy; D012890:Sleep; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
chemical_list: D000700:Analgesics