TY - JOUR
T1 - Pain and adverse effects after caesarean delivery
T2 - A nationwide prospective cohort study
AU - Duch, Patricia
AU - Wikkelsø, Anne
AU - Jørgensen, Christoffer C
AU - Jakobsen, Janus C
AU - Mathiesen, Ole
AU - Nørskov, Anders K
AU - Nedergaard, Helene
N1 - Copyright © 2025 European Society of Anaesthesiology and Intensive Care. Unauthorized reproduction of this article is prohibited.
PY - 2026/1/1
Y1 - 2026/1/1
N2 - BACKGROUND: Caesarean delivery can cause severe postoperative pain that can adversely affect recovery. However, balancing effective pain management while minimising the risk of opioid-related adverse effects remains a clinical challenge.OBJECTIVE: In this nationwide study, we aimed to describe the incidence and severity of acute pain and adverse effects of opioid administration following the first hours and days after elective caesarean delivery.DESIGN: Prospective nationwide Danish multicentre cohort study.SETTING: All maternity hospitals in Denmark over a 6-month period during 2023-2024.PATIENTS: Patients having elective caesarean delivery.INTERVENTION: Patient-reported outcomes on pain [Numeric Rating Scale (NRS) 0 to 10] and opioid-related adverse effects were collected using text message-based questionnaires via smartphone contact at 6, 12, 18, 24, and 48 h postcaesarean delivery, and on days 7 and 30.MAIN OUTCOME MEASURES: The two primary outcomes were pain on mobilisation at 24 h, and adverse events of opioid administration (namely, nausea, vomiting, dizziness, pruritus and urinary retention) within 24 h.RESULTS: In total, 738 patients were included from 19 of 22 Danish maternity hospitals. Median [IQR] pain during mobilisation 24 h postcaesarean delivery was NRS 5 [3 to 6], peaking at 12 h postoperatively with NRS 6 [5 to 8]. Median oral morphine equivalents (OME) within the first 24 h were 30 [20 to 50] mg. Adverse effects peaked 6 h postoperatively, with pruritus being the most common. Within the first 24 h 59 [95% confidence interval (CI), 55 to 63]% reported severe pain (NRS ≥ 7) and 55 (95% CI, 51 to 59)% reported opioid-related adverse effects.CONCLUSIONS: In Denmark, severe pain after caesarean delivery affects more than half the patients within the first 24 h, peaking at 12 h. Additionally, most report moderate or severe opioid-related adverse effects. These results underscore the need to optimise pain management, particularly during the first 24 h when pain is highest. The results can inform both patients and healthcare providers about expected pain trajectories and serve as the foundation for future research, and guide interventions.TRIAL REGISTRATION: www.clinicaltrials.gov , NCT06012747.
AB - BACKGROUND: Caesarean delivery can cause severe postoperative pain that can adversely affect recovery. However, balancing effective pain management while minimising the risk of opioid-related adverse effects remains a clinical challenge.OBJECTIVE: In this nationwide study, we aimed to describe the incidence and severity of acute pain and adverse effects of opioid administration following the first hours and days after elective caesarean delivery.DESIGN: Prospective nationwide Danish multicentre cohort study.SETTING: All maternity hospitals in Denmark over a 6-month period during 2023-2024.PATIENTS: Patients having elective caesarean delivery.INTERVENTION: Patient-reported outcomes on pain [Numeric Rating Scale (NRS) 0 to 10] and opioid-related adverse effects were collected using text message-based questionnaires via smartphone contact at 6, 12, 18, 24, and 48 h postcaesarean delivery, and on days 7 and 30.MAIN OUTCOME MEASURES: The two primary outcomes were pain on mobilisation at 24 h, and adverse events of opioid administration (namely, nausea, vomiting, dizziness, pruritus and urinary retention) within 24 h.RESULTS: In total, 738 patients were included from 19 of 22 Danish maternity hospitals. Median [IQR] pain during mobilisation 24 h postcaesarean delivery was NRS 5 [3 to 6], peaking at 12 h postoperatively with NRS 6 [5 to 8]. Median oral morphine equivalents (OME) within the first 24 h were 30 [20 to 50] mg. Adverse effects peaked 6 h postoperatively, with pruritus being the most common. Within the first 24 h 59 [95% confidence interval (CI), 55 to 63]% reported severe pain (NRS ≥ 7) and 55 (95% CI, 51 to 59)% reported opioid-related adverse effects.CONCLUSIONS: In Denmark, severe pain after caesarean delivery affects more than half the patients within the first 24 h, peaking at 12 h. Additionally, most report moderate or severe opioid-related adverse effects. These results underscore the need to optimise pain management, particularly during the first 24 h when pain is highest. The results can inform both patients and healthcare providers about expected pain trajectories and serve as the foundation for future research, and guide interventions.TRIAL REGISTRATION: www.clinicaltrials.gov , NCT06012747.
KW - Adult
KW - Analgesics, Opioid/adverse effects
KW - Cesarean Section/adverse effects
KW - Cohort Studies
KW - Denmark/epidemiology
KW - Female
KW - Humans
KW - Incidence
KW - Pain Management/methods
KW - Pain Measurement/methods
KW - Pain, Postoperative/epidemiology
KW - Pregnancy
KW - Prospective Studies
KW - Abdominis plane block
KW - Recovery
KW - Section
KW - Implementation
KW - Intrathecal morphine
KW - Wound infiltration
KW - Metaanalysis
KW - Analgesic efficacy
KW - Quality
KW - Anesthesia
U2 - 10.1097/EJA.0000000000002277
DO - 10.1097/EJA.0000000000002277
M3 - Article
C2 - 40956058
SN - 0265-0215
VL - 43
SP - 34
EP - 44
JO - European Journal of Anaesthesiology
JF - European Journal of Anaesthesiology
IS - 1
ER -