Incidence and predictors of moderate to severe postoperative pain after cesarean delivery among parturients receiving spinal anesthesia at the selected southern Ethiopian Governmental Hospital 2023: a multicenter prospective single-armed cohort study

BACKGROUND: Inadequate postoperative pain management predisposes patients to delayed recovery, impairs mother-infant interaction, prolongs hospital stay, and increases the risk of chronic pain development. In resource-limited settings, postoperative pain management remains challenging because of inadequate administration of analgesics and a high patient-to-nurse ratio, which limits adequate pain assessment and timely management. OBJECTIVE: To assess the incidence and predictors of moderate to severe postoperative pain after cesarean delivery among parturients receiving spinal anesthesia at two Southern Governmental teaching Hospitals between March1 and May 30, 2023. METHODS: A multicenter prospective cohort study involving 205 parturients was conducted after ethical approval was obtained from the institutional review board. Participants were selected using a systematic sampling technique. Postoperative pain severity was assessed using the Numeric Rating Scale within the first 24 h after surgery. Binary logistic regression was used to identify independent risk factors for postoperative pain. A p value of 0.05 was considered the cutoff point to test for statistical significance in multivariate logistic regression analysis. RESULTS: In our study, the incidence of moderate to severe postoperative pain after cesarean delivery was 71.2% within the first 24 h. On the basis of the multivariable analysis, preoperative anxiety (AOR: 2.849, 95% CI: 1.276, 6.359), previous cesarean delivery (AOR: 3.571, 95% CI: 1.536, 8.300) and transverse incision (AOR: 6.965, 95% CI: 2.469, 19.652) were significantly associated with moderate to severe postoperative pain after cesarean delivery. Abdominal field blocks were associated with a reduced likelihood of postoperative pain (AOR = 0.035, 95% CI: 0.009-0.139). CONCLUSION: A high proportion of parturients experienced moderate to severe postoperative pain after cesarean delivery. Preoperative anxiety, previous cesarean delivery, and transverse incision were significant predictors of postoperative pain, whereas abdominal field blocks had a protective effect. Routine postoperative pain assessment and the implementation of multimodal analgesic strategies, including regional analgesic techniques, are recommended to improve post-cesarean pain management.