Citation (Vancouver):

O’Carroll JE, Conti D, Gao N, Carvalho B, Sultan P. Incidence of pain during cesarean delivery with neuraxial anesthesia: an international, prospective cohort study. Anesthesiology. 2025. doi:10.1097/ALN.0000000000005868.

Study at a glance

- Design and setting: Prospective, international multicenter cohort (15 mainly high-resource obstetric centers); consecutive cesarean deliveries under neuraxial anesthesia with day-1 postpartum interviews (N=3,693).

- Population and overall incidence: Women undergoing elective (n=1,684) and non-elective (n=2,009) cesarean delivery; 7.6% reported intraoperative pain (≈1 in 13), typically moderate–severe (median NRS 6/10 among those with pain).

- By neuraxial technique: Pain was least frequent with spinal anesthesia (4.4%), higher with combined spinal–epidural (8.2%) and highest with epidural top-up (13.1%); adjusted odds of pain vs spinal were OR 2.01 for CSE and OR 2.92 for epidural top-up.

- Other predictors: No clear independent association with age, race, ethnicity, urgency, or intrapartum status; Spanish as preferred language was associated with higher adjusted odds of intraoperative pain vs English (OR 1.79; 95% CI 1.02–3.14).

- Satisfaction: Among those who experienced intraoperative pain, about 10% reported dissatisfaction with how their pain was managed.

- Certainty: Observational design with multivariable adjustment but moderate overall risk of bias and likely residual confounding; GRADE certainty for causal interpretations of these associations is low.