• H-Y Park, Y-W Park, J-W Hwang, S-H Do, and H-S Na.
• Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seoul, Korea (Republic of).
• Anaesthesist. 2020 May 1; 69 (5): 352-358.

BackgroundIntense noxious input from the periphery may result in central sensitization and hyperexcitability, thus accentuating subsequent postoperative pain. Parturients who undergo emergency cesarean section (C-sec) after experiencing labor pain often develop labor pain-induced sensitization.ObjectiveThis retrospective study evaluated whether parturients without epidural labor analgesia (ELA) who underwent emergency C‑sec, experienced more severe postoperative pain and required more rescue analgesics during the postoperative period.MethodsThe institution's medical database was searched for parturients who underwent emergency C‑sec under spinal anesthesia for any reason between January 2013 and December 2016. Those who underwent elective C‑sec under spinal anesthesia were included as the reference arm. Parturients were divided into three groups: ELA, no-ELA and elective. Characteristics of patients and perioperative outcomes were evaluated. As primary outcomes, numerical rating scale (NRS) for postoperative pain (0-10) was recorded up to 96 h postoperatively, and use of rescue analgesics was evaluated at 6, 24, and 48 h postoperatively.ResultsIn the ELA, no-ELA, and elective groups, 61, 73, and 88 parturients, respectively, were ultimately enrolled. The NRS for pain were similar among the three groups, except at 6 h postoperatively. Parturients in the no-ELA group demonstrated significantly higher NRS at 6 h postoperatively than those in the ELA group (P = 0.01).More patients in the no-ELA group required rescue analgesics than in the ELA (P = 0.001) and elective groups (P < 0.001) at 6-24 h postoperatively. Moreover, the proportion of patients requiring rescue analgesics ≥2 times was also significantly higher in the no-ELA group (vs. the ELA group, P = 0.004; vs. the elective group, P < 0.001).ConclusionParturients undergoing emergency C‑sec without ELA management during labor experienced greater postoperative pain and a greater use of rescue analgesics during the postoperative period. The findings suggest that administration of ELA before emergency C‑sec may act as pre-emptive analgesia against postoperative pain.

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