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Length of incision may affect pain after caesarean delivery

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The length of surgical incision may affect the pain experienced after a caesarean delivery, with both short and long ones associated with increased pain, suggests a US study.

Based on their findings, researchers recommended an optimal range for incision length to be between 12 and 17cm, and advise that neither shorter nor longer incisions be performed if possible.

“This ‘Goldilocks effect’ of surgical incision length on pain outcomes has not been previously reported”

Ruth Landau

The study included 690 women undergoing elective cesarean delivery, of which 37% had a repeat caesarean, who were evaluated pre-operatively and followed for up to 12 months.

Both the shorter and longer extremes of surgical incision length were associated with increased pain. Women with shorter incisions – less than 12cm – were more likely to report higher pain scores immediately after delivery.

The study authors suggested that this was likely to indicate intense tissue stretching during delivery.

In addition, women with longer incisions – more than 17cm – were also more likely to report higher pain scores, including wound hyperalgesia, or an increased sensitivity to pain around the incision.

Meanwhile, chronic pain after caesarean delivery was found to be extremely rare, with less than 3% of women reporting chronic pain one year after their caesarean delivery.

Among those who underwent a repeat caesarean, chronic pain was reported by 4.7%, compared to 1.6% of the women who had a caesarean for the first time.

Overall, at one year, surgical-related pain symptoms, mostly described as “tender pain”, were reported by 4.7% of women, and neuropathic symptoms such as itching, tingling or numbing were reported by 19%.

Lead researcher Dr Ruth Landau, from Columbia University Medical Center in New York, said: “To our knowledge, this ‘Goldilocks effect’ of surgical incision length on pain outcomes has not been previously reported.”

“We were surprised to find tremendous variability in surgical incision length”

Ruth Landau

Dr Landau said the finding “merits further investigation to unravel the effects of short-term tissue stretch and increased tissue trauma on acute and chronic post-caesarean pain”.

She highlighted that the researchers “were surprised to find tremendous variability” in surgical incision length.

“While the median length was 15cms, the range was from nine to 23cms, which may in part be due to the surgeons’ practice and patients’ body characteristics,” she said.

She added: “Caesarean section is a unique surgical model, because obstetricians may perform the exact same surgical procedure repeatedly on the same woman.

“Therefore, studies that identify the ideal length of surgical incision in cesareans, taking into account women’s body build and previous scar, if present, are important,” said Dr Landau.

The study findings were presented earlier this week at the Anesthesiology 2017 conference in Boston.

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