Preoperative scar hyperalgesia is associated with post-operative pain in women undergoing a repeat Caesarean delivery

C. M. Ortner, M. Granot, P. Richebé, M. Cardoso, L. Bollag, R. Landau

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Over 1.4 million Caesarean deliveries are performed annually in the United States, out of which 30% are elective repeat procedures. Post-operative hyperalgesia is associated with an increased risk for persistent post-surgical pain; however, there are no data on whether residual scar hyperalgesia (SHA) from a previous Caesarean delivery (CD) persists until the next delivery. We hypothesized that residual SHA may be present in a substantial proportion of women and is associated with increased post-operative pain. Methods: One hundred and sixty-three women scheduled for a repeat CD under spinal anaesthesia were enrolled into the study. Mechanical temporal summation (mTS) and SHA index were measured preoperatively. SHA was considered present when the index was >0. Post-operative pain scores at 12, 24 and 48 h and wound hyperalgesia (WHA) at 48 h were recorded. Results: SHA was present in 67 women 41% with a median SHA index of 0.42 (Q25 = 0.25; Q75 = 1.1, range 0.03-4.25). Women with SHA had overall higher post-operative pain scores and SHA was correlated with preoperative mTS (r = 0.164, p < 0.05), post-operative pain severity (r = 0.25, p < 0.002) and WHA at 48 h (r = 0.608, p < 0.001). Severe pain (visual analogue pain scale-S48 ≥ 7, n = 20) was predicted with a sensitivity and specificity of 60% and 62%, respectively. Positive predictive value was 18% and negative predictive value was 92%. Conclusions: Preoperative SHA is present in 41% of women scheduled for repeat CD and is associated with increased mTS and post-operative pain. Screening for preoperative SHA may predict women at risk for increased post-operative pain, and guide post-operative analgesia to include anti-hyperalgesic drugs.

Original languageEnglish
Pages (from-to)111-123
Number of pages13
JournalEuropean Journal of Pain
Volume17
Issue number1
DOIs
StatePublished - Jan 2013

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

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