{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T02:51:07Z","timestamp":1780541467872,"version":"3.54.1"},"reference-count":66,"publisher":"MDPI AG","issue":"22","license":[{"start":{"date-parts":[[2023,11,9]],"date-time":"2023-11-09T00:00:00Z","timestamp":1699488000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Cesarean section (CS) is the most widely performed and one of the most painful surgeries. This study investigated postoperative pain after CS using patient-related outcomes (PROs) to identify risk factors for severe pain. The secondary outcome was to evaluate the influence of surgery indication (primary CS (PCS) vs. urgent CS (UCS)). This multi-center, prospective cohort study included data submitted to the pain registry \u201cquality improvement in postoperative pain treatment\u201d (QUIPS) between 2010 and 2020. In total, 11,932 patients were evaluated. Median of maximal pain was 7.0 (numeric rating scale (NRS) 0 to 10); 53.9% suffered from severe pain (NRS \u2265 7), this being related to impairment of mood, ambulation, deep breathing and sleep, as well as more vertigo, nausea and tiredness (p &lt; 0.001). Distraction, relaxation, mobilization, having conversations, patient-controlled analgesia (PCA) and pain monitoring were shown to be protective for severe pain (p &lt; 0.001). Maximal pain in PCS and UCS was similar, but UCS obtained more analgesics (p &lt; 0.001), and experienced more impairment of ambulation (p &lt; 0.001) and deep breathing (p &lt; 0.05). Severe pain has a major effect on daily-life activities and recovery after CS, and depends on modifiable factors. More effort is needed to improve the quality of care after CS.<\/jats:p>","DOI":"10.3390\/jcm12226999","type":"journal-article","created":{"date-parts":[[2023,11,9]],"date-time":"2023-11-09T03:42:40Z","timestamp":1699501360000},"page":"6999","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Risk Factors for Severe Pain and Impairment of Daily Life Activities after Cesarean Section\u2014A Prospective Multi-Center Study of 11,932 Patients"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1705-1536","authenticated-orcid":false,"given":"Norah L. A.","family":"Emrich","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Tasc\u00f3n Padr\u00f3n","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3637-7067","authenticated-orcid":false,"given":"Marcus","family":"Komann","sequence":"additional","affiliation":[{"name":"Department for Anesthesiology and Intensive Care Medicine, University Hospital of Jena, Am Klinikum 1, 07740 Jena, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christin","family":"Arnold","sequence":"additional","affiliation":[{"name":"Department for Anesthesiology and Intensive Care Medicine, University Hospital of Jena, Am Klinikum 1, 07740 Jena, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9994-660X","authenticated-orcid":false,"given":"Johannes","family":"Dreiling","sequence":"additional","affiliation":[{"name":"Department for Anesthesiology and Intensive Care Medicine, University Hospital of Jena, Am Klinikum 1, 07740 Jena, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2982-7696","authenticated-orcid":false,"given":"Winfried","family":"Mei\u00dfner","sequence":"additional","affiliation":[{"name":"Department for Anesthesiology and Intensive Care Medicine, University Hospital of Jena, Am Klinikum 1, 07740 Jena, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3625-7097","authenticated-orcid":false,"given":"Brigitte","family":"Strizek","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8284-4669","authenticated-orcid":false,"given":"Ulrich","family":"Gembruch","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1892-790X","authenticated-orcid":false,"given":"Jorge","family":"Jim\u00e9nez Cruz","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,11,9]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"22148","DOI":"10.1038\/s41598-021-01597-5","article-title":"Acute Postoperative Pain in 23 Procedures of Gynaecological Surgery Analysed in A Prospective Open Registry Study on Risk Factors and Consequences for the Patient","volume":"11","author":"Cruz","year":"2021","journal-title":"Sci. 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