COMPARISON OF POSTOPERATIVE PAIN SEVERITY AND ANALGESIC CONSUMPTION WITHIN 24 HOURS BETWEEN PRIMARY AND REPEAT CESAREAN SECTIONS UNDER SPINAL ANESTHESIA: A PROSPECTIVE COHORT STUDY

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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

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