(818) Is there a difference in pain perception after cesarean delivery among women with endometriosis?

Friday, February 10, 2023

10:30 AM – 12:00 PM

Objective: Patients with endometriosis known to have altered pain perception. Cesarean delivery (CD) is one of the most prevalent surgeries performed worldwide. Proper pain control following CD is of clinical importance to the recovery and relief of patients. We aimed to assess pain perception and analgetic use after CD in women with and without endometriosis.

Study Design: This is a case control retrospective study. Included women diagnosed with endometriosis, based on clinical or surgical findings, who underwent CD between 2014-2022. Controls were matched to the study group by maternal age, BMI (kg/m²), parity, number of previous CDs and by CD indication, in a 1:1 ratio. Post operative visual analogue scale (VAS) pain scores, at each post operative day (POD) were compared between the groups. Pain intensity was measured and compared using the VAS, range 0 (no pain) to 10 (worst pain). The standard pain relief analgesia on POD 0 includes fixed oral treatment with paracetamol, diclofenac and morphine-sulphate. Starting POD1 treatment protocol includes fixes oral paracetamol and diclofenac only. Additional need for analgesics from the standard pain relief protocol were compared between the study and control groups.

Results: As compare to the controls (n=71) the endometriosis group (n=71) was characterized by higher rates of IVF pregnancies and previous abdominal surgeries other than CD (p < 0.001 for both). There were no between groups differences in maternal characteristics. The endometriosis group had higher mean VAS scores as compared to control, with a significant difference of VAS score on POD 1 (1.75 ± 1.13 vs 1.36±0.9, p= 0.041, OR 1.45). Among patients who needed additional analgesics beyond the standard protocol at POD 0, more women in the endometriosis group used opioids rather than milder analgesics as compared to controls, 56% vs. 25.8%, respectively, p=0.021.

Conclusion: Increased post-operative pain in women with endometriosis after CD implies that personalized pain relief protocols should be adjusted for women with endometriosis.

Primary & Presenting Author(s)

Lior Heresco, MD
Meir Medical Center
Kfar Saba, HaMerkaz, Israel

Coauthor(s)

RS
Ron Schonman, MD
Department of Obstetrics and Gynecology, Meir Medical Center
Kfar Saba, Israel, Israel
Gal Cohen, MD
The Department of Obstetrics and Gynecology, Meir Medical Centerartment of Obstetrics and Gynecology, Meir Medical Center
Kfar Saba, Israel, Israel
Hanoch Schreiber, MD
The Department of Obstetrics and Gynecology, Meir Medical Centerartment of Obstetrics and Gynecology, Meir Medical Center
Kfar Saba, Israel, Israel
OW
Omer Weitzner, MD
Meir Medical Center
Kfar Saba, HaMerkaz, Israel
YD
Yair Daykan, MD
Meir Medical Center
Kfar Saba, HaMerkaz, Israel
ZK
Zvi Klein, MD
Meir Medical Center
Kfar Saba, HaMerkaz, Israel
Michal Kovo, MD, PhD
Vice Chair Obstetrics and Gynecology
Meir Medical Center
Tel Aviv , Israel, Israel
YY
Yael Yagur, BSc, MD
Meir medical center
Flushing, Israel