- Pain during cesarean delivery can result in long-term psychological sequelae, including depression and post-traumatic stress disorder, but the incidence of pain during cesarean delivery due to inadequate neuraxial anesthesia is unclear.
- This prospective cohort study evaluated the incidence of pain during cesarean delivery utilizing neuraxial anesthesia.
- 3,693 patients from 15 academic centers located in the United States and Canada were included in this study; of these, 45.6% underwent elective cesarean deliveries and the remaining 54.4% underwent urgent or emergent procedures.
- Patients were evaluated at approximately 24 hours postpartum and asked whether they experienced pain during their cesarean delivery, and if so, how severe their pain was on a scale from 1-10.
- Overall, 7.6% of patients reported experiencing pain during their cesarean deliveries.
- Compared with elective cesarean deliveries, urgent or emergent cesarean deliveries were associated with an increased incidence of intraoperative pain as well as higher numeric pain scores.
- Cesarean deliveries performed after an epidural top-up were associated with a higher incidence of pain (13.1%) compared with cesarean deliveries performed after spinal anesthesia (4.4%).
- Spanish-speaking patients were more likely to report having experienced pain than other cohorts.
- Of 282 patients who reported experiencing intraoperative pain, 29 (10.3%) were not satisfied with how the anesthesia team managed their pain.
- The authors concluded that intraoperative pain during cesarean delivery with neuraxial anesthesia is fairly common, and that further work is required by the anesthesia community to address this issue.
- The authors suggest several potential interventions to reduce the rate, severity, and long-term impact of pain during cesarean delivery:
- Preoperatively, anesthesia professionals should have a comprehensive discussion with their patients regarding pain control during cesarean delivery, with the goal of reaching a shared decision about the anesthesia plan and pain management options.
- Interpreters should be utilized if English is not the patient’s preferred language.
- Intraoperatively, anesthesia professionals should exercise heightened vigilance and perform a careful block assessment for non-elective cases, particularly when epidural top-up is the planned mode of anesthesia, as these variables are associated with an elevated risk of intraoperative pain.
Summary of "Incidence of Pain during Cesarean Delivery with Neuraxial Anesthesia: An International, Prospective Cohort Study"
Summary published April 20, 2026
