{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T17:23:30Z","timestamp":1786123410222,"version":"build-2736575974"},"reference-count":19,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2016,4]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND:<\/jats:title>\n                    <jats:p>Improved pain control after cesarean delivery remains a challenging objective. Poorly treated acute pain following delivery is associated with an increased risk of chronic pain and depression. This study was conducted to determine whether the addition of systemic acetaminophen and an increased dose of intrathecal morphine would further reduce acute pain. The primary outcome was pain intensity with movement at 24 hours postoperatively. Secondary measures included persistent pain and depression at 8 weeks.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS:<\/jats:title>\n                    <jats:p>Seventy-four parturients scheduled for elective cesarean delivery under spinal anesthesia that were predicted to be above the 80th percentile for evoked pain intensity based on a 3-item preoperative screening questionnaire were enrolled. Patients in the intervention group received 300 mcg spinal morphine and 1 gram acetaminophen every 6 hours for 24 hours postoperatively. Patients in the control group received 150 mcg spinal morphine and placebo tablets. All patients received scheduled ibuprofen by mouth and IV morphine patient-controlled analgesia. At 24 hours, patients rated their pain intensity with movement, at rest, on average, and worst score using a visual analog scale for pain (100-mm unmarked line). The presence of persistent pain and depression was assessed at 8 weeks using the Edinburgh postpartum depression survey.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>\n                      Providing a higher dose of spinal morphine combined with systemic acetaminophen to patients predicted to be at high risk for severe post\u2013cesarean delivery pain significantly reduced evoked pain scores with movement at 24 hours (mean \u00b1 SD: 46 \u00b1 25 mm in control group versus 31 \u00b117 mm in intervention group,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.009; 95% confidence interval for the difference between means: 4 mm, 26 mm). There was no difference in the incidence of persistent pain (13% (4\/30) in control group versus 10% (3\/30) in intervention group,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &gt; 0.99), or depression at 8 weeks postoperatively (10% (3\/30) in control group versus 13% (4\/30) in intervention group,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &gt; 0.99).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS:<\/jats:title>\n                    <jats:p>Adding a higher dose of intrathecal morphine and oral acetaminophen to a multimodal pain regimen in patients predicted to be at risk for high acute postpartum pain after cesarean delivery results in a significant reduction of acute postoperative pain scores at 24 hours.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1213\/ane.0000000000000695","type":"journal-article","created":{"date-parts":[[2015,3,25]],"date-time":"2015-03-25T06:51:17Z","timestamp":1427266277000},"page":"1114-1119","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":45,"title":["A Randomized Controlled Trial Comparing Two Multimodal Analgesic Techniques in Patients Predicted to Have Severe Pain After Cesarean Delivery"],"prefix":"10.1213","volume":"122","author":[{"given":"Jessica L.","family":"Booth","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lynnette C.","family":"Harris","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James C.","family":"Eisenach","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"and Peter H.","family":"Pan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"R1-23-20250810","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1111\/j.1399-6576.2004.00271.x","article-title":"Chronic pain following Caesarean section.","volume":"48","author":"Nikolajsen","year":"2004","journal-title":"Acta Anaesthesiol Scand"},{"key":"R2-23-20250810","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1016\/j.pain.2008.07.011","article-title":"Severity of acute pain after childbirth, but not type of delivery, predicts persistent pain and postpartum depression.","volume":"140","author":"Eisenach","year":"2008","journal-title":"Pain"},{"key":"R3-23-20250810","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1016\/j.ijoa.2009.03.013","article-title":"Persistent pain after caesarean section and vaginal birth: a cohort study.","volume":"19","author":"Kainu","year":"2010","journal-title":"Int J Obstet Anesth"},{"key":"R4-23-20250810","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1097\/00000542-200603000-00007","article-title":"Multifactorial preoperative predictors for postcesarean section pain and analgesic requirement.","volume":"104","author":"Pan","year":"2006","journal-title":"Anesthesiology"},{"key":"R5-23-20250810","doi-asserted-by":"crossref","first-page":"1422","DOI":"10.1097\/00000542-200306000-00018","article-title":"Postcesarean section pain prediction by preoperative experimental pain assessment.","volume":"98","author":"Granot","year":"2003","journal-title":"Anesthesiology"},{"key":"R6-23-20250810","doi-asserted-by":"crossref","first-page":"1170","DOI":"10.1097\/ALN.0b013e31828e156f","article-title":"Predicting acute pain after cesarean delivery using three simple questions.","volume":"118","author":"Pan","year":"2013","journal-title":"Anesthesiology"},{"key":"R7-23-20250810","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1037\/0022-3514.67.2.319","article-title":"Behavioral inhibition, behavioral activation, and affective responses to impending reward and punishment: The BISBAS scales.","volume":"67","author":"Carver","year":"1994","journal-title":"J Pers Soc Psychol"},{"key":"R8-23-20250810","doi-asserted-by":"crossref","first-page":"4882","DOI":"10.1523\/JNEUROSCI.5634-08.2009","article-title":"The anatomy of the mesolimbic reward system: a link between personality and the placebo analgesic response.","volume":"29","author":"Schweinhardt","year":"2009","journal-title":"J Neurosci"},{"key":"R9-23-20250810","doi-asserted-by":"crossref","first-page":"782","DOI":"10.1192\/bjp.150.6.782","article-title":"Detection of postnatal depression. 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