Severe pain during local anesthesia infiltration, actual spinal anesthesia procedure, and during cesarean delivery, and their association with post-cesarean pain and recovery: a planned secondary analysis of a prospective cohort study

doi:10.1016/j.ijoa.2026.104924

Obstetric anesthesia

Severe pain during local anesthesia infiltration, actual spinal anesthesia procedure, and during cesarean delivery, and their association with post-cesarean pain and recovery: a planned secondary analysis of a prospective cohort study

Int J Obstet AnesthPublished 22 Mar 2026Planned secondary analysis of a prospective cohort study

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Authors' conclusion

Severe pain during local anesthesia infiltration, severe intraoperative pain, and higher body mass index were associated with severe post-cesarean pain, while severe intraoperative pain and primary cesarean delivery were associated with poor recovery.

Study context

Population: Women undergoing elective cesarean delivery under spinal anesthesia
Participants: 146 women

Comparison: Severe pain (verbal numeric scale ≥ 7) during local anaesthesia infiltration, spinal procedure, or intraoperatively vs no severe pain
Primary endpoint: Severe post-cesarean pain (verbal numeric scale ≥ 7) and poor recovery (ObsQoR-10 <75)
Follow-up: 24 h

Methodological detailstwo tertiary hospitals, Firth penalized logistic regression

Two tertiary hospitals
Firth penalized logistic regression

Primary result

As reported in the abstract

Severe post-cesarean pain (24 h) and poor recovery

Odds ratio (95% CI)P value

Severe pain during local anesthesia infiltrationsevere post-cesarean pain; adjusted

6.66(1.21–36.72)

P = 0.030

Severe intraoperative painsevere post-cesarean pain; adjusted

16.69(1.66–148.16)

P = 0.019

Higher BMI (per kg/m²)severe post-cesarean pain; adjusted

1.08(1.00–1.16)

P = 0.037

Severe intraoperative painpoor recovery; adjusted

9.27(1.55–64.46)

P = 0.016

Primary cesarean deliverypoor recovery; adjusted

2.96(1.20–7.33)

P = 0.019

Per kg/m², as printed

Severe post-cesarean pain: 14 (9.6%)
Poor recovery: 27 (18.5%)

Further findings

Incidence of severe procedural pain

During local anesthesia infiltration: 14 (9.6%)
During actual spinal anesthesia procedure: 11 (7.5%)
Intraoperatively: 5 (3.4%)

Original publication

Severe pain during local anesthesia infiltration, actual spinal anesthesia procedure, and during cesarean delivery, and their association with post-cesarean pain and recovery: a planned secondary analysis of a prospective cohort study. Int J Obstet Anesth. Published 22 March 2026. doi:10.1016/j.ijoa.2026.104924

Read the original article ↗

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