{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T12:08:56Z","timestamp":1782821336390,"version":"3.54.5"},"reference-count":21,"publisher":"Public Library of Science (PLoS)","issue":"4","license":[{"start":{"date-parts":[[2023,4,18]],"date-time":"2023-04-18T00:00:00Z","timestamp":1681776000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Few data are available on the intensity of pain that women experience during the first five days after vaginal childbirth. Moreover, it is unknown if the use of neuraxial labor analgesia has any impact on the level of postpartum pain.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>We performed a retrospective cohort study based on chart review of all women who delivered vaginally at an urban teaching hospital between April 2017 and April 2019. The primary outcome was the area under the curve of pain score on numeric rating scale (NRS) documented in electronic medical records for five days postpartum (NRS-AUC<jats:sub>5days<\/jats:sub>). Secondary outcomes included peak NRS score, doses of oral and intravenous analgesics consumed during the first five days postpartum, and relevant obstetric outcomes. Logistic regression was used to examine the associations between the use of neuraxial labor analgesia and pain-related outcomes adjusting for potential confounders.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>During the study period, 778 women (38.6%) underwent vaginal delivery with neuraxial analgesia and 1240 women (61.4%) delivered without neuraxial analgesia. Median (Interquartile range) of NRS-AUC<jats:sub>5days<\/jats:sub> was 0.17 (0.12\u20130.24) among women who received neuraxial analgesia and 0.13 (0.08\u20130.19) among women who did not (p&lt;0.001). Women who received neuraxial analgesia were more likely to require the first- and second-line analgesics postpartum than women who did not: diclofenac (87.9% vs. 73.0%, p&lt; 0.001, respectively); acetaminophen (40.7% vs. 21.0%, p&lt; 0.001, respectively). The use of neuraxial labor analgesia was independently associated with increased odds of having NRS-AUC<jats:sub>5days<\/jats:sub> in the highest 20 percentile (adjusted odds ratio [aOR] 2.03; 95% confidence interval [CI] 1.55\u20132.65), having peak NRS \u2265 4 (aOR 1.54; 95% CI 1.25\u20131.91) and developing hemorrhoids during the postpartum hospitalization (aOR 2.13; 95% CI 1.41\u20133.21) after adjusting for relevant confounders.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>Although women who used neuraxial labor analgesia had slightly higher pain scores and increased analgesic requirement during postpartum hospitalization, pain after vaginal childbirth was overall mild. The small elevation in the pain burden in neuraxial group does not seem to be clinically relevant and should not influence women\u2019s choice to receive labor analgesia.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0284106","type":"journal-article","created":{"date-parts":[[2023,4,18]],"date-time":"2023-04-18T17:25:35Z","timestamp":1681838735000},"page":"e0284106","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":3,"title":["Acute pain and analgesic requirement after vaginal childbirth with and without neuraxial labor analgesia\u2013Retrospective cohort study"],"prefix":"10.1371","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6919-6465","authenticated-orcid":true,"given":"Ayumi","family":"Maeda","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7089-229X","authenticated-orcid":true,"given":"Gen","family":"Shimada","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nobuko","family":"Fujita","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rimu","family":"Suzuki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michiko","family":"Yamanaka","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Osamu","family":"Takahashi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9474-0020","authenticated-orcid":true,"given":"Tokujiro","family":"Uchida","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6259-3388","authenticated-orcid":true,"given":"Yasuko","family":"Nagasaka","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2023,4,18]]},"reference":[{"key":"pone.0284106.ref001","first-page":"CD000331","article-title":"Epidural versus non-epidural or no analgesia for pain management in labour","volume":"5","author":"M Anim-Somuah","year":"2018","journal-title":"Cochrane Database Syst Rev"},{"issue":"1","key":"pone.0284106.ref002","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":"JC Eisenach","year":"2008","journal-title":"Pain"},{"issue":"2","key":"pone.0284106.ref003","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1016\/j.bja.2018.04.033","article-title":"Prediction of outliers in pain, analgesia requirement, and recovery of function after childbirth: a prospective observational cohort study","volume":"121","author":"R Komatsu","year":"2018","journal-title":"Br J Anaesth"},{"key":"pone.0284106.ref004","unstructured":"Japanese Association of Obstetricians and Gynecologists. National survey on deliveries in Japan. 2017. 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