ab02b2292091ac93220f2ad253e53d0d 325967.pdf 5bf955d7854ef20568baf2460b7e29e02a90f9b3 325967.pdf 8e5a931e9baafe71f9f6a9b6f4d787f5e6e2cbbba209809a211d940076e84f80 325967.pdf Title: Assessing the Experience and Management of Acute Post-Operative Pain from Caesarean Delivery: A Multi-Centre Cohort Study Subject: Background: Caesarean section is considered one of the surgeries with the highest prevalence of postoperative pain, yet this is often underestimated and undertreated. This study was aimed at evaluating the prevalence and severity of postoperative pain, assessing which analgesic strategy is the most effective and identifying those risk factors associated with poorer analgesic results. Methods: A multi-centre observational study was conducted on 514 women undergoing elective caesarean section. The primary endpoints included postoperative pain severity at rest and with movement at 6 and 24 h. Results: The combination of intrathecal morphine and fentanyl with acetaminophen and Non Steroid Anti-inflammatory Drugs (NSAIDs) was associated with better pain control than any of the following treatments: intrathecal fentanyl with systemic acetaminophen and NSAIDs (2.49 2.04 vs. 3.91 2.75, ES = -0.610, p = 0.01), elastomeric pump at 6 h at rest (2.49 2.04 vs. 4.10 2.86, ES -0.733, p = 0.04) and with movement (4.44 2.41 vs. 6.14 3.08, ES -0.671, p = 0.01) or epidural analgesia (4.44 2.41 vs. 5.65 2.57, ES -0.496, p = 0.02). No risk factors predicting poorer postoperative analgesia were found. Conclusions: The prevalence of postoperative pain control after elective caesarean section is high. The best analgesic postoperative regimen includes intrathecal morphine together with fentanyl and systemic analgesics. No risk factors associated with poorer outcomes were found. Keywords: caesarean section; pain; postoperative; pain measurement; analgesia; obstetric Author: Carles Espinós Ramírez, Gisela Roca Amatria, Pere Castellví Obiols, David Martínez-Rodríguez, Mireia Raynard, Blanca Viscasillas Draper, Paula Masgoret, Cristina Rodríguez Cosmen, Laura Subirana Giménez, Maria Martinez García, Gerard Mestres, Martha Melo, Alèxia Nebot Galindo, Natàlia Montero Gaig, Virginia Sánchez-Migallón, David Valencia Royo, Nuria Lara Pacheco Comino, Inés Bermejo Perez, Cristina Santos Farré, Lluís Toll Salillas, Arnau Alonso Gelabert, Marta Homs, Patricia Ribas, Claudia Teixell, Ana María Plaza Moral, Bea Tena, Adrián Fernández Castiñeira, Mireia Armengol Gay, Beatriz Fort Pelai, Carolina García Bartoló, Carolina Mestre Iniesta, Anna Peig Font, Paula Gil Esteller, Jean Louis Clave, Sandra Gasca Pera, Astrid Batalla and Verónica Vargas Raidi Creator: LaTeX with hyperref Producer: pdfTeX-1.40.25 CreationDate: Wed Jul 2 09:21:06 2025 CEST ModDate: Wed Jul 2 09:23:43 2025 CEST Custom Metadata: no Metadata Stream: no Tagged: no UserProperties: no Suspects: no Form: none JavaScript: no Pages: 13 Encrypted: no Page size: 595.276 x 841.89 pts (A4) Page rot: 0 File size: 858059 bytes Optimized: no PDF version: 1.7 name type encoding emb sub uni object ID ------------------------------------ ----------------- ---------------- --- --- --- --------- TXYQVB+VnURWPalladioL-Bold Type 1 Custom yes yes yes 10 0 EJHFUU+VnURWPalladioL Type 1 Custom yes yes yes 16 0 RWKDWS+URWPalladioL-Roma Type 1 Custom yes yes yes 21 0 IZWGMK+URWPalladioL-Bold Type 1 Custom yes yes yes 27 0 VROAXG+URWPalladioL-Ital Type 1 Custom yes yes yes 32 0 KOSUXD+CMSY10 Type 1 Builtin yes yes yes 58 0 OVNEXW+EURM10 Type 1 Builtin yes yes yes 69 0 SYFPBV+CMMI10 Type 1 Builtin yes yes yes 74 0 WBVKDJ+URWPalladioL-BoldItal Type 1 Custom yes yes yes 85 0 CNEPKJ+PalatinoLinotype-Bold CID TrueType Identity-H yes yes yes 93 0 CNEPLK+PalatinoLinotype-Roman CID TrueType Identity-H yes yes yes 99 0 CNEPLL+PalatinoLinotype-Italic CID TrueType Identity-H yes yes yes 105 0 CNEPKJ+PalatinoLinotype-Bold CID TrueType Identity-H yes yes yes 125 0 CNEPLK+PalatinoLinotype-Roman CID TrueType Identity-H yes yes yes 131 0 CNEPLL+PalatinoLinotype-Italic CID TrueType Identity-H yes yes yes 137 0 Jhove (Rel. 1.28.0, 2023-05-18) Date: 2026-03-07 04:41:59 CET RepresentationInformation: 325967.pdf ReportingModule: PDF-hul, Rel. 1.12.4 (2023-03-16) LastModified: 2026-03-06 12:28:06 CET Size: 858059 Format: PDF Version: 1.7 Status: Well-Formed and valid SignatureMatches: PDF-hul MIMEtype: application/pdf PDFMetadata: Objects: 298 FreeObjects: 1 IncrementalUpdates: 0 DocumentCatalog: PageLayout: SinglePage PageMode: UseNone Outlines: Item: Title: Introduction Destination: section.1 Item: Title: Materials and Methods Destination: section.2 Children: Item: Title: Study Design Destination: subsection.2.1 Item: Title: Participants Destination: subsection.2.2 Item: Title: Outcomes Destination: subsection.2.3 Item: Title: Data Collection Destination: subsection.2.4 Item: Title: Sample Size Destination: subsection.2.5 Item: Title: Comparison of the Different Analgesic Techniques Destination: subsection.2.6 Item: Title: Statistical Analysis Destination: subsection.2.7 Item: Title: Results Destination: section.3 Item: Title: Discussion Destination: section.4 Item: Title: References Destination: section.5 Info: Title: Assessing the Experience and Management of Acute Post-Operative Pain from Caesarean Delivery: A Multi-Centre Cohort Study Author: Carles Espinós Ramírez, Gisela Roca Amatria, Pere Castellví Obiols, David Martínez-Rodríguez, Mireia Raynard, Blanca Viscasillas Draper, Paula Masgoret, Cristina Rodríguez Cosmen, Laura Subirana Giménez, Maria Martinez García, Gerard Mestres, Martha Melo, Alèxia Nebot Galindo, Natàlia Montero Gaig, Virginia Sánchez-Migallón, David Valencia Royo, Nuria Lara Pacheco Comino, Inés Bermejo Perez, Cristina Santos Farré, Lluís Toll Salillas, Arnau Alonso Gelabert, Marta Homs, Patricia Ribas, Claudia Teixell, Ana María Plaza Moral, Bea Tena, Adrián Fernández Castiñeira, Mireia Armengol Gay, Beatriz Fort Pelai, Carolina García Bartoló, Carolina Mestre Iniesta, Anna Peig Font, Paula Gil Esteller, Jean Louis Clave, Sandra Gasca Pera, Astrid Batalla and Verónica Vargas Raidi Subject: Background: Caesarean section is considered one of the surgeries with the highest prevalence of postoperative pain, yet this is often underestimated and undertreated. This study was aimed at evaluating the prevalence and severity of postoperative pain, assessing which analgesic strategy is the most effective and identifying those risk factors associated with poorer analgesic results. Methods: A multi-centre observational study was conducted on 514 women undergoing elective caesarean section. The primary endpoints included postoperative pain severity at rest and with movement at 6 and 24 h. Results: The combination of intrathecal morphine and fentanyl with acetaminophen and Non Steroid Anti-inflammatory Drugs (NSAIDs) was associated with better pain control than any of the following treatments: intrathecal fentanyl with systemic acetaminophen and NSAIDs (2.49 2.04 vs. 3.91 2.75, ES = -0.610, p = 0.01), elastomeric pump at 6 h at rest (2.49 2.04 vs. 4.10 2.86, ES -0.733, p = 0.04) and with movement (4.44 2.41 vs. 6.14 3.08, ES -0.671, p = 0.01) or epidural analgesia (4.44 2.41 vs. 5.65 2.57, ES -0.496, p = 0.02). No risk factors predicting poorer postoperative analgesia were found. Conclusions: The prevalence of postoperative pain control after elective caesarean section is high. The best analgesic postoperative regimen includes intrathecal morphine together with fentanyl and systemic analgesics. No risk factors associated with poorer outcomes were found. Keywords: caesarean section; pain; postoperative; pain measurement; analgesia; obstetric Creator: LaTeX with hyperref Producer: pdfTeX-1.40.25 CreationDate: Wed Jul 02 09:21:06 CEST 2025 ModDate: Wed Jul 02 09:23:43 CEST 2025 ID: 0xea6a8c74fdcc93d1db2cf02261ed6823, 0xea6a8c74fdcc93d1db2cf02261ed6823 Filters: FilterPipeline: FlateDecode Fonts: Type1: Font: BaseFont: VROAXG+URWPalladioL-Ital FontSubset: true FirstChar: 46 LastChar: 122 FontDescriptor: FontName: VROAXG+URWPalladioL-Ital Flags: Symbolic FontBBox: -170, -305, 1010, 941 FontFile: true EncodingDictionary: Differences: true ToUnicode: true Font: BaseFont: EJHFUU+VnURWPalladioL FontSubset: true FirstChar: 160 LastChar: 177 FontDescriptor: FontName: EJHFUU+VnURWPalladioL Flags: Symbolic FontBBox: -166, -283, 1021, 943 FontFile: true EncodingDictionary: Differences: true ToUnicode: true Font: BaseFont: RWKDWS+URWPalladioL-Roma FontSubset: true FirstChar: 2 LastChar: 250 FontDescriptor: FontName: RWKDWS+URWPalladioL-Roma Flags: Symbolic FontBBox: -166, -283, 1021, 943 FontFile: true EncodingDictionary: Differences: true ToUnicode: true Font: BaseFont: OVNEXW+EURM10 FontSubset: true FirstChar: 22 LastChar: 22 FontDescriptor: FontName: OVNEXW+EURM10 Flags: Symbolic FontBBox: -32, -243, 1060, 720 FontFile: true ToUnicode: true Font: BaseFont: WBVKDJ+URWPalladioL-BoldItal FontSubset: true FirstChar: 112 LastChar: 112 FontDescriptor: FontName: WBVKDJ+URWPalladioL-BoldItal Flags: Symbolic FontBBox: -170, -300, 1073, 935 FontFile: true EncodingDictionary: Differences: true ToUnicode: true Font: BaseFont: TXYQVB+VnURWPalladioL-Bold FontSubset: true FirstChar: 160 LastChar: 177 FontDescriptor: FontName: TXYQVB+VnURWPalladioL-Bold Flags: Symbolic FontBBox: -152, -301, 1000, 935 FontFile: true EncodingDictionary: Differences: true ToUnicode: true Font: BaseFont: KOSUXD+CMSY10 FontSubset: true FirstChar: 0 LastChar: 21 FontDescriptor: FontName: KOSUXD+CMSY10 Flags: Symbolic FontBBox: -29, -960, 1116, 775 FontFile: true ToUnicode: true Font: BaseFont: SYFPBV+CMMI10 FontSubset: true FirstChar: 60 LastChar: 62 FontDescriptor: FontName: SYFPBV+CMMI10 Flags: Symbolic FontBBox: -32, -250, 1048, 750 FontFile: true ToUnicode: true Font: BaseFont: IZWGMK+URWPalladioL-Bold FontSubset: true FirstChar: 3 LastChar: 243 FontDescriptor: FontName: IZWGMK+URWPalladioL-Bold Flags: Symbolic FontBBox: -152, -301, 1000, 935 FontFile: true EncodingDictionary: Differences: true ToUnicode: true Pages: Page: Sequence: 1 Annotations: Annotation: Subtype: Link Rect: 97, 177, 152, 186 Annotation: Subtype: Link Rect: 34, 165, 102, 174 Annotation: Subtype: Link Rect: 36, 75, 152, 84 Annotation: Subtype: Link Rect: 34, 63, 89, 72 Annotation: Subtype: Link Rect: 34, 773, 179, 809 Annotation: Subtype: Link Rect: 515, 773, 560, 809 Annotation: Subtype: Link Rect: 162, 643, 173, 656 Annotation: Subtype: Link Rect: 277, 643, 288, 656 Annotation: Subtype: Link Rect: 394, 643, 405, 656 Annotation: Subtype: Link Rect: 538, 643, 549, 656 Annotation: Subtype: Link Rect: 322, 629, 333, 642 Annotation: Subtype: Link Rect: 277, 616, 288, 628 Annotation: Subtype: Link Rect: 372, 616, 383, 628 Annotation: Subtype: Link Rect: 456, 616, 467, 628 Annotation: Subtype: Link Rect: 145, 603, 156, 614 Annotation: Subtype: Link Rect: 407, 601, 419, 614 Annotation: Subtype: Link Rect: 524, 601, 535, 614 Annotation: Subtype: Link Rect: 466, 587, 477, 600 Annotation: Subtype: Link Rect: 371, 574, 382, 587 Annotation: Subtype: Link Rect: 338, 545, 349, 559 Annotation: Subtype: Link Rect: 439, 545, 450, 559 Annotation: Subtype: Link Rect: 547, 545, 558, 559 Annotation: Subtype: Link Rect: 107, 531, 118, 545 Annotation: Subtype: Link Rect: 423, 27, 560, 37 Annotation: Subtype: Link Rect: 34, 379, 87, 398 Page: Sequence: 2 Annotations: Annotation: Subtype: Link Rect: 321, 510, 328, 519 ActionDest: 154 Annotation: Subtype: Link Rect: 328, 510, 335, 519 ActionDest: 158 Annotation: Subtype: Link Rect: 189, 496, 196, 505 ActionDest: 158 Annotation: Subtype: Link Rect: 384, 496, 391, 505 ActionDest: 158 Annotation: Subtype: Link Rect: 199, 426, 206, 435 ActionDest: 158 Annotation: Subtype: Link Rect: 243, 398, 250, 407 ActionDest: 158 Annotation: Subtype: Link Rect: 528, 343, 535, 352 ActionDest: 158 Annotation: Subtype: Link Rect: 488, 328, 495, 338 ActionDest: 158 Annotation: Subtype: Link Rect: 246, 301, 253, 310 ActionDest: 158 Annotation: Subtype: Link Rect: 327, 259, 339, 268 ActionDest: 158 Annotation: Subtype: Link Rect: 455, 245, 467, 254 ActionDest: 158 Annotation: Subtype: Link Rect: 293, 231, 305, 240 ActionDest: 158 Annotation: Subtype: Link Rect: 191, 189, 203, 198 ActionDest: 158 Annotation: Subtype: Link Rect: 213, 120, 225, 129 ActionDest: 158 Page: Sequence: 3 Annotations: Annotation: Subtype: Link Rect: 176, 627, 256, 639 Annotation: Subtype: Link Rect: 262, 588, 274, 597 ActionDest: 158 Annotation: Subtype: Link Rect: 197, 216, 209, 225 ActionDest: 158 Annotation: Subtype: Link Rect: 231, 202, 243, 211 ActionDest: 158 Page: Sequence: 4 Annotations: Annotation: Subtype: Link Rect: 520, 662, 532, 671 ActionDest: 158 Annotation: Subtype: Link Rect: 544, 648, 556, 657 ActionDest: 158 Page: Sequence: 5 Annotations: Annotation: Subtype: Link Rect: 203, 643, 210, 655 ActionDest: 79 Page: Sequence: 6 Annotations: Annotation: Subtype: Link Rect: 411, 714, 418, 726 ActionDest: 82 Annotation: Subtype: Link Rect: 469, 714, 476, 726 ActionDest: 82 Page: Sequence: 7 Annotations: Annotation: Subtype: Link Rect: 212, 756, 219, 768 ActionDest: 116 Annotation: Subtype: Link Rect: 339, 616, 346, 628 ActionDest: 119 Page: Sequence: 8 Annotations: Annotation: Subtype: Link Rect: 300, 217, 307, 226 ActionDest: 148 Page: Sequence: 9 Annotations: Annotation: Subtype: Link Rect: 397, 442, 409, 451 ActionDest: 158 Annotation: Subtype: Link Rect: 501, 428, 508, 437 ActionDest: 158 Annotation: Subtype: Link Rect: 363, 400, 375, 409 ActionDest: 158 Annotation: Subtype: Link Rect: 375, 400, 387, 409 ActionDest: 158 Annotation: Subtype: Link Rect: 418, 289, 424, 298 ActionDest: 158 Annotation: Subtype: Link Rect: 425, 288, 432, 298 ActionDest: 158 Annotation: Subtype: Link Rect: 432, 289, 444, 298 ActionDest: 158 Annotation: Subtype: Link Rect: 390, 135, 402, 144 ActionDest: 158 Annotation: Subtype: Link Rect: 405, 135, 417, 144 ActionDest: 158 Annotation: Subtype: Link Rect: 381, 80, 393, 89 ActionDest: 158 Annotation: Subtype: Link Rect: 396, 80, 408, 89 ActionDest: 161 Page: Sequence: 10 Annotations: Annotation: Subtype: Link Rect: 274, 730, 286, 740 ActionDest: 161 Annotation: Subtype: Link Rect: 286, 730, 298, 740 ActionDest: 161 Annotation: Subtype: Link Rect: 332, 717, 344, 726 ActionDest: 161 Annotation: Subtype: Link Rect: 347, 661, 359, 670 ActionDest: 161 Annotation: Subtype: Link Rect: 474, 661, 486, 670 ActionDest: 161 Annotation: Subtype: Link Rect: 492, 619, 504, 628 ActionDest: 161 Annotation: Subtype: Link Rect: 275, 452, 287, 461 ActionDest: 161 Annotation: Subtype: Link Rect: 375, 354, 387, 364 ActionDest: 161 Annotation: Subtype: Link Rect: 308, 243, 320, 252 ActionDest: 161 Annotation: Subtype: Link Rect: 465, 229, 477, 238 ActionDest: 161 Page: Sequence: 11 Annotations: Annotation: Subtype: Link Rect: 171, 64, 208, 74 Annotation: Subtype: Link Rect: 214, 64, 250, 74 Page: Sequence: 12 Annotations: Annotation: Subtype: Link Rect: 429, 756, 467, 767 Annotation: Subtype: Link Rect: 473, 756, 509, 767 Annotation: Subtype: Link Rect: 482, 731, 519, 742 Annotation: Subtype: Link Rect: 465, 718, 503, 729 Annotation: Subtype: Link Rect: 339, 692, 377, 703 Annotation: Subtype: Link Rect: 429, 679, 467, 690 Annotation: Subtype: Link Rect: 153, 655, 190, 665 Annotation: Subtype: Link Rect: 371, 628, 409, 639 Annotation: Subtype: Link Rect: 294, 603, 332, 614 Annotation: Subtype: Link Rect: 338, 603, 374, 614 Annotation: Subtype: Link Rect: 298, 565, 335, 576 Annotation: Subtype: Link Rect: 377, 526, 414, 537 Annotation: Subtype: Link Rect: 421, 526, 457, 537 Annotation: Subtype: Link Rect: 109, 489, 146, 499 Annotation: Subtype: Link Rect: 152, 489, 188, 499 Annotation: Subtype: Link Rect: 59, 438, 96, 448 Annotation: Subtype: Link Rect: 59, 412, 96, 422 Annotation: Subtype: Link Rect: 102, 412, 138, 422 Annotation: Subtype: Link Rect: 159, 373, 197, 384 Annotation: Subtype: Link Rect: 113, 336, 150, 346 Annotation: Subtype: Link Rect: 486, 309, 523, 320 Annotation: Subtype: Link Rect: 376, 284, 414, 295 Annotation: Subtype: Link Rect: 374, 245, 411, 256 Annotation: Subtype: Link Rect: 520, 233, 557, 244 Annotation: Subtype: Link Rect: 519, 220, 557, 231 Annotation: Subtype: Link Rect: 59, 208, 95, 218 Annotation: Subtype: Link Rect: 422, 182, 459, 193 Annotation: Subtype: Link Rect: 465, 182, 501, 193 Annotation: Subtype: Link Rect: 59, 144, 96, 154 Annotation: Subtype: Link Rect: 102, 144, 138, 154 Annotation: Subtype: Link Rect: 95, 106, 132, 116 Annotation: Subtype: Link Rect: 95, 67, 132, 78 Page: Sequence: 13 Annotations: Annotation: Subtype: Link Rect: 202, 731, 240, 742 Annotation: Subtype: Link Rect: 182, 706, 219, 716 Annotation: Subtype: Link Rect: 255, 667, 293, 678 Annotation: Subtype: Link Rect: 377, 603, 415, 614 Annotation: Subtype: Link Rect: 182, 578, 219, 588 Annotation: Subtype: Link Rect: 225, 578, 261, 588 Annotation: Subtype: Link Rect: 435, 565, 472, 576 Annotation: Subtype: Link Rect: 478, 565, 514, 576 Annotation: Subtype: Link Rect: 223, 539, 261, 550 Annotation: Subtype: Link Rect: 460, 513, 498, 524 Annotation: Subtype: Link Rect: 122, 489, 159, 499 Checksum: d01620db Type: CRC32 Checksum: ab02b2292091ac93220f2ad253e53d0d Type: MD5 Checksum: 5bf955d7854ef20568baf2460b7e29e02a90f9b3 Type: SHA-1 Checksum: 8e5a931e9baafe71f9f6a9b6f4d787f5e6e2cbbba209809a211d940076e84f80 Type: SHA-256