ABSTRACT

Background Cesarean section is one of the most commonly performed surgical procedures worldwide and is frequently associated with moderate to severe postoperative pain. While overall pain after cesarean delivery is well described, evidence comparing pain intensity and analgesic use between primary and repeat cesarean sections remains limited.

Objective To compare postoperative pain severity and total analgesic consumption within the first 24 hours among women undergoing primary versus repeat cesarean sections under spinal anesthesia at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia, from January 1 to March 30, 2025.

Methods A prospective cohort study was conducted among 203 women who underwent cesarean delivery under spinal anesthesia. Participants were selected using systematic random sampling and categorized into primary and repeat cesarean groups. Demographic and clinical characteristics were summarized using descriptive statistics. Group comparisons were performed using independent t-tests or Mann–Whitney U tests for continuous variables and Chi-square tests for categorical variables. A p-value < 0.05 was considered statistically significant.

Results Women undergoing repeat cesarean sections experienced significantly higher postoperative pain. During movement, 92.1% of women in the repeat group reported moderate to severe pain compared with 66.7% in the primary group (p < 0.001). At rest, moderate to severe pain occurred in 74.3% of the repeat group versus 52.9% of the primary group (p = 0.002). Pain scores within the first 6 hours were also higher in the repeat group (median NRS 7, IQR 7–8) than in the primary group (median NRS 5, IQR 4–7; p < 0.001). Total analgesic consumption was significantly greater among women in the repeat group (243.3 ± 98.4 mg) compared with the primary group (146.3 ± 82.5 mg; p < 0.001).

Conclusions Repeat cesarean sections are associated with higher early postoperative pain and increased analgesic requirements. These findings support the need for individualized and intensified pain management strategies for women undergoing repeat cesarean delivery.

Clinical trial number Not applicable

Competing Interest Statement

The authors have declared no competing interest.

Funding Statement

Yes

Author Declarations

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

The study protocol was reviewed and approved by the IRB of Addis Ababa University. Ethical approval was granted under protocol number Anes 02//2024//25. The study was conducted in accordance with the principles of the Declaration of Helsinki. Written informed consent was obtained from all participants prior to enrollment.

I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.

Yes

I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

Yes

I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.

Yes

Data Availability

The data cannot be shared publicly because they contain sensitive patient information. Access to the data can be requested from the Institutional Review Board of Addis Ababa University (contact: ethicsaau.edu.et) for researchers who meet the criteria for confidential data access.

LIST OF ACRONMYS AND ABBREVIATIONSASAAmerican society of anesthesiologyBMIBody mass indexCSCesarean sectionCDCesarean deliveryCIConfidence intervalETBEthiopian BirrG.CGregorian colandersIQRInterquartile rangeIMIntramuscularlyIVIntravenouslyNRSNumerical rating scaleOROdd ratioPIPrincipal investigatorPOPPostoperative painPACUPost-anesthesia care unitPCAPatient-Controlled AnalgesiaSPSSStatistical package for the social sciencesSDStandard deviationWHOWorld Health OrganizationRCTRandomized controlled trialRRRelative riskTASHTikur Anbessa Specialized HospitalUSAUnited States of AmericaVASVisual analog scale