Effects of daytime variation on pain intensity and analgesic requirement after cesarean section: a retrospective and prospective study

Abstract

Background This study compared postoperative pain and analgesic requirements in women who underwent cesarean section (CS) in the morning and afternoon.Summary background data It is unclear whether there was difference in postoperative pain intensity and analgesic requirements between morning and afternoon CS.Methods A single-center retrospective cohort study was conducted to compare postoperative analgesic requirements between women who underwent CS during 06:00–12:00 (morning group, n = 104) and 12:00–18:00 (afternoon group, n = 104). Then, a prospective cohort study was conducted, including 55 women each in the morning and afternoon groups. The primary outcome was area under the curve (AUC) of the pain NRS during 24 h after the CS, and analgesic consumption was recorded. Pressure pain sensitivity and serum interleukin-6 and endorphin levels were detected pre- and postoperatively.Results The frequency of analgesic requirements 24 h after CS in the afternoon group was significantly higher than morning group in the retrospective cohort. The AUC of pain NRS and analgesic consumption during 24 h after afternoon CS were significantly higher than those after morning procedures. Significantly lower pressure pain tolerance, higher postoperative serum endorphin levels and higher levels of interleukin-6 were found in the afternoon group compared to those preoperatively, but not in the morning group.Conclusion CS performed in the afternoon predicted severer postoperative pain compared to those performed in the morning, which might be associated with lower postoperative pain tolerance and more drastic responses to surgery. This finding needs to be considered in pain treatment after CS in the future.Clinical trial number and registry URL: ChiCTR2000039720, www.chictr.org.cn.

Keywords

• Surgery
• postoperative pain
• numerical rating scale
• morning
• afternoon
• endorphin