Anxiety About Surgery and Anticipated Intraoperative Pain Independently Predict Pain During Extension of Epidural Analgesia for Intrapartum Cesarean Delivery: A Prospective Cohort Study

Few studies have investigated the effects of preoperative psychological factors on pain during surgery. In this study, the association of preoperative psychological factors with the occurrence of intraoperative pain, the need for opioid supplementation, and the conversion to general anesthesia were examined during the extension of epidural analgesia for cesarean delivery. In parturients who received epidural labor analgesia, the visual analog scale (VAS; 0–100 mm) were used to evaluate trait anxiety, anxiety about surgery, and anticipated intraoperative pain before emergency cesarean delivery performed because of failure to progress. During surgery, the occurrence of intraoperative pain, need for opioid supplementation, and conversion to general anesthesia were observed. Spearman rank order correlation revealed a positive correlation between anxiety about surgery and the occurrence of intraoperative pain (correlation coefficient = 0.23, P = 0.008), between anticipated intraoperative pain and the occurrence of intraoperative pain (correlation coefficient = 0.31, P < 0.001), and between anticipated intraoperative pain and the need for opioid supplementation (correlation coefficient = 0.35, P = 0.012). Anxiety about surgery (odds ratio = 1.04 [1.02–1.07], P = 0.032) and anticipated intraoperative pain (odds ratio = 1.06 [1.02–1.11], P = 0.002) were independent predictors of the occurrence of intraoperative pain according to multiple logistic regression analysis, after controlling for maternal age and pain VAS score before cesarean delivery during labor pain. Anxiety about surgery and anticipated intraoperative pain are independent predictors of the occurrence of intraoperative pain during extension of epidural labor analgesia for intrapartum cesarean delivery performed because of failure to progress