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Preoperative scar hyperalgesia is associated with post‐operative pain in women undergoing a repeat Caesarean delivery
Author(s) -
Ortner C.M.,
Granot M.,
Richebé P.,
Cardoso M.,
Bollag L.,
Landau R.
Publication year - 2013
Publication title -
european journal of pain
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.305
H-Index - 109
eISSN - 1532-2149
pISSN - 1090-3801
DOI - 10.1002/j.1532-2149.2012.00171.x
Subject(s) - medicine , anesthesia , hyperalgesia , caesarean delivery , visual analogue scale , pain score , predictive value , caesarean section , surgery , pregnancy , nociception , receptor , biology , genetics
Background Over 1.4 million Caesarean deliveries are performed annually in the U nited S tates, 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 ( Q 25 = 0.25; Q 75 = 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‐ S 48 ≥ 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.