Shoulder tip pain during and after caesarean section under spinal anaesthesia: Incidence, Severity, and associated factors in a tertiary hospital in Ethiopia

Shoulder tip pain (STP) is an underrecognized complication of cesarean section under spinal anesthesia, potentially impairing maternal comfort and early neonatal care. Despite the increasing cesarean delivery rate in Ethiopia, data on the incidence and contributing factors of STP are lacking. This study aimed to assess the incidence, severity, and associated factors of STP among women undergoing elective cesarean section under spinal anesthesia. A prospective cohort study was conducted at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia between June 2023 and May 2024. A total of 165 women undergoing elective cesarean section under spinal anesthesia were enrolled. Data on demographics, perioperative variables, and STP characteristics were collected. Logistic regression analyses were performed to identify factors associated with STP incidence and severity. Significance was set at p < 0.05. STP occurred in 49.6% of participants, with 14.5% experiencing intraoperative and 38.8% postoperative pain. The right side was the most commonly affected (70.4%).Among those affected, 20.7% reported mild pain, 48.7% moderate pain, and 30.4% severe pain. Blood loss > 500 mL was significantly associated with STP incidence (AOR = 4.43, p = 0.001). Severity was influenced by prior cesarean history, intraoperative positioning, block height, and intra operative bleeding > 500 ml. No significant associations were found with age, BMI, gravidity, or duration of surgery. The incidence of shoulder tip pain during and after caesarean section is high and clinically significant in Ethiopia. The pain is frequently moderate to severe and is associated with greater intraoperative blood loss.