Predictors Of Visceral Pain: An Observational Analysis of Lower Segment Cesarean Section Under Spinal Anesthesia

Background: Despite the adequacy of sensory blockade, a significant proportion of mothers undergoing LSCS experience intraoperative discomfort, particularly visceral pain, necessitating additional analgesia. Aim: The study was conducted to assess the predictors of visceral pain of intra-operative period during caesarean section under spinal anesthesia. Methods: A profile of 106 parturients who underwent emergency LSCS under spinal anesthesia were included in this prospective observational study. The study included patients classified as American Society of Anaesthesiologists (ASA) Class I and II, aged between 18 and 40years, who were scheduled to undergo lower abdominal surgeries and provided informed consent for spinal anaesthesia. Pain and discomfort during the surgical procedure were evaluated at various stages, including uterine exteriorization, oxytocin administration, and mopping. Pain was assessed on a five-point scale. Pain assessments and intraoperative observations were performed by a blinded investigator. All data were analyzed using statistical software. Continuous variables were presented as mean ± standard deviation. A p-value <0.05 was considered statistically significant. Results: Out of 106 patients, 71 (67%) had intraoperative pain, whereas 35 (33%) did not. The results of a proportions Z-test statistical analysis showed a highly significant difference (p < 0.001), indicating that patients receiving LSCS under spinal anesthesia frequently experience intraoperative pain. Statistical analysis revealed a p-value of 0.77, indicating no statistically association between fasting status and the occurrence of pain during the procedure. The p-value of 0.34 suggests that there is no statistically significant association between spinal level and the occurrence of chest pain during the procedure. Statistical analysis yielded a p-value of 0.0015, indicating a highly significant association between the level of block and the occurrence of pain. Among the 71 patients who reported experiencing pain, intraoperative events such as mopping, exteriorization of the uterus, and oxytocin administration were having statistically significant correlation topain. Mopping emerged as the most strongly associated factor, with 69 out of 71 patients (97.2%) experiencing pain during this procedure. The exteriorization of the uterus was also a significant factor, with 40 patients (56.3%) reporting pain, potentially due to the stretching and traction exerted on intra-abdominal structures. Similarly, oxytocin administration was associated pain presentin 41 patients (57.7%). Conclusion: Intraoperative visceral pain during cesarean delivery is significantly associated with lower sensory block levels and specific surgical maneuvers such as oxytocin administration, uterine exteriorization, and peritoneal mopping. Achieving a higher block level reduced pain incidence, and stopping the provoking stimulus often relieved discomfort. Despite stable hemodynamics, the psychological impact of pain remains a concern. These findings support individualized, non-pharmacologic pain management strategies