Postsurgical pain syndromes: Chronic pain after hysterectomy and cesarean section

Abstract

Persistent postsurgical pain may be an underreported phenomenon after cesarean section (CS) and hysterectomy with a large impact on daily living. Estimated incidences of persistent pain following CS and hysterectomy are 6% to 18% and 5% to 32%, respectively. Variations are partly the result of different postoperative time intervals at assessment and definitions of pain, but occurrence is consistent across nations and cultures. Severe acute postoperative pain predicts increased risk for persistent postsurgical pain in multiple studies and also contributes to the risk for postpartum depression. Other factors such as preexisting pain problems, genetics, psychological state, and gender may also impact persistent postsurgical pain. Types of anesthesia and analgesics used, as well as surgical approaches, have an impact on postcesarean and hysterectomy pain. This article reviews information on the occurrence of and risk factors for severe postoperative pain after CS and hysterectomy. Treatments of incisional pain and intractable pelvic pain through somatic blocks, sympathetic blockade with lumbar sympathetic, hypogastric, and ganglion impar blocks, and recent spinal cord stimulator use are summarized.