{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,27]],"date-time":"2025-11-27T20:56:27Z","timestamp":1764276987924,"version":"build-2065373602"},"reference-count":20,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2019,12,16]],"date-time":"2019-12-16T00:00:00Z","timestamp":1576454400000},"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>Background: Cesarean deliveries represent a large percentage of deliveries worldwide. Patients undergoing repeat cesarean deliveries are known to have increased risks for surgical complications. However, little is known regarding potential differences in pain. We sought to compare postoperative opioid consumption and pain scores in opioid na\u00efve patients undergoing primary versus repeat non-emergent cesarean delivery. Methods: This was a retrospective cohort study. Patient inclusion criteria included: having a non-emergent cesarean delivery, receiving a spinal procedure for surgical anesthesia without general anesthesia, and following the same postoperative pain management protocols. Exclusion criteria included: history of opioid tolerance, illicit drug use, or prior, non-obstetric, major abdominal surgery. The primary outcome marker was total morphine equivalents consumed 0\u201372 h post-procedure compared between the primary versus repeat cesarean delivery groups. Secondary outcome markers were opioid consumption and pain scores in 24-h period increments for the first 72 h postoperatively. Results: 1617 patients were screened. 217 primary and 377 repeat cesarean deliveries met criteria for comparison. Reduced opioid consumption was demonstrated for the total opioid consumption 0\u201372 h for the repeat cesarean delivery group (median = 35) compared to the primary cesarean delivery group (median = 58), p = 0.0005. When divided into 24-h periods, differences were demonstrated for the 24\u201348 and 48\u201372 h periods but not the 0\u201324 h period. Pain scores did not differ statistically. Conclusion: Opioid na\u00efve obstetric patients who undergo non-emergent repeat cesarean delivery demonstrate lower opioid consumption in the postoperative period. Providers should be aware of this potential difference in order to better educate patients and provide adequate pain management. Highlights: The study reviewed differences in opioid consumption between primary and repeat cesarean deliveries. All patients received the same protocol for spinal dosage and pain management. Repeat cesarean deliveries were associated with lower opioid consumption.<\/jats:p>","DOI":"10.3390\/jcm8122221","type":"journal-article","created":{"date-parts":[[2019,12,17]],"date-time":"2019-12-17T02:59:01Z","timestamp":1576551541000},"page":"2221","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Comparison of Postoperative Opioid Consumption and Pain Scores in Primary Versus Repeat Cesarean Delivery in Opioid Na\u00efve Patients"],"prefix":"10.3390","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3167-3414","authenticated-orcid":false,"given":"Amanda","family":"Chao","sequence":"first","affiliation":[{"name":"Department of Anesthesiology, Loma Linda University Medical Center, 11234 Anderson Street, MC-2532-D, Loma Linda, CA 92354, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4531-7346","authenticated-orcid":false,"given":"Ioana","family":"Pasca","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Loma Linda University Medical Center, 11234 Anderson Street, MC-2532-D, Loma Linda, CA 92354, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matthew","family":"Alschuler","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Loma Linda University Medical Center, 11234 Anderson Street, MC-2532-D, Loma Linda, CA 92354, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jay","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Loma Linda University Medical Center, 11234 Anderson Street, MC-2532-D, Loma Linda, CA 92354, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michelle","family":"Woodfin","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Loma Linda University Medical Center, 11234 Anderson Street, MC-2532-D, Loma Linda, CA 92354, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Justin","family":"Pugh","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Loma Linda University Medical Center, 11234 Anderson Street, MC-2532-D, Loma Linda, CA 92354, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Briahnna","family":"Austin","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Loma Linda University Medical Center, 11234 Anderson Street, MC-2532-D, Loma Linda, CA 92354, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mark","family":"Ringer","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Loma Linda University Medical Center, 11234 Anderson Street, MC-2532-D, Loma Linda, CA 92354, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8670-7300","authenticated-orcid":false,"given":"Davinder","family":"Ramsingh","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Loma Linda University Medical Center, 11234 Anderson Street, MC-2532-D, Loma Linda, CA 92354, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2019,12,16]]},"reference":[{"key":"ref_1","first-page":"1","article-title":"Births: Final data for 2016","volume":"67","author":"Martin","year":"2018","journal-title":"Natl. Vital. Stat. Rep."},{"key":"ref_2","first-page":"489","article-title":"Indications for and risks of elective cesarean section","volume":"112","author":"Mylonas","year":"2015","journal-title":"Dtsch. Arztebl. Int."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"430","DOI":"10.1111\/j.1552-6909.2007.00160.x","article-title":"Postoperative pain after cesarean birth affects breastfeeding and infant care","volume":"36","author":"Karlstrom","year":"2007","journal-title":"J. Obste.t Gynecol. Neonatal Nurs."},{"key":"ref_4","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":"ref_5","doi-asserted-by":"crossref","first-page":"622","DOI":"10.1111\/aogs.12613","article-title":"Risk factors for persistent pain and its influence on maternal wellbeing after cesarean section","volume":"94","author":"Niklasson","year":"2015","journal-title":"Acta Obstet. Gynecol. Scand."},{"key":"ref_6","unstructured":"American College of Obstetricians and Gynecologists (2018). ACOG Committee Opinion No. 742: Postpartum pain management. Obstet. Gynecol., 132, e35\u2013e43."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1097\/AOG.0000000000002095","article-title":"Postdischarge opioid use after cesarean delivery","volume":"130","author":"Osmundson","year":"2017","journal-title":"Obstet. Gynecol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1606","DOI":"10.1213\/ANE.0000000000002658","article-title":"Predicting severity of acute pain after cesarean delivery: A narrative review","volume":"126","author":"Gamez","year":"2018","journal-title":"Anesth. Analg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1432","DOI":"10.1213\/ANE.0000000000002918","article-title":"A pain in the Abs: Predicting post-cesarean analgesia","volume":"126","author":"Wanderer","year":"2018","journal-title":"Anesth. Analg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1002\/j.1532-2149.2012.00171.x","article-title":"Preoperative scar hyperalgesia is associated with post-operative pain in women undergoing a repeat Caesarean delivery","volume":"17","author":"Ortner","year":"2013","journal-title":"Eur. J. Pain"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1500","DOI":"10.1016\/j.ijsu.2014.07.014","article-title":"Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): Explanation and elaboration","volume":"12","author":"Vandenbroucke","year":"2014","journal-title":"Int. J. Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"270","DOI":"10.4300\/JGME-D-13-00056.1","article-title":"Randomized controlled trial of spaced education for pediatric residency education","volume":"6","author":"Mathes","year":"2014","journal-title":"J. Grad. Med. Educ."},{"key":"ref_13","unstructured":"Opioid Calculator (2019, December 14). Practical Pain Management. Available online: https:\/\/opioidcalculator.practicalpainmanagement.com."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1097","DOI":"10.1097\/AJP.0000000000000219","article-title":"Effects of combining dexmedetomidine and opioids for postoperative intravenous patient-controlled analgesia: A systematic review and meta-analysis","volume":"31","author":"Peng","year":"2015","journal-title":"Clin. J. Pain"},{"key":"ref_15","first-page":"IC07","article-title":"Factors affecting post caesarean pain intensity among women in the northern peninsular of malaysia","volume":"11","author":"Jasim","year":"2017","journal-title":"J. Clin. Diagn. Res."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1097\/AOG.0000000000002093","article-title":"Patterns of opioid prescription and use after cesarean delivery","volume":"130","author":"Bateman","year":"2017","journal-title":"Obstet. Gynecol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1016\/j.pain.2005.09.008","article-title":"Risk factors for acute pain and its persistence following breast cancer surgery","volume":"119","author":"Katz","year":"2005","journal-title":"Pain"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"502","DOI":"10.1016\/j.jpain.2012.12.020","article-title":"Predictors of acute postsurgical pain and anxiety following primary total hip and knee arthroplasty","volume":"14","author":"Pinto","year":"2013","journal-title":"J. Pain"},{"key":"ref_19","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":"ref_20","doi-asserted-by":"crossref","first-page":"e013413","DOI":"10.1136\/bmjopen-2016-013413","article-title":"Possible relationship between general and pregnancy-related anxiety during the first half of pregnancy and the birth process: A prospective cohort study","volume":"7","author":"Koelewijn","year":"2017","journal-title":"BMJ Open"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/8\/12\/2221\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T13:42:41Z","timestamp":1760190161000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/8\/12\/2221"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,12,16]]},"references-count":20,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2019,12]]}},"alternative-id":["jcm8122221"],"URL":"https:\/\/doi.org\/10.3390\/jcm8122221","relation":{},"ISSN":["2077-0383"],"issn-type":[{"type":"electronic","value":"2077-0383"}],"subject":[],"published":{"date-parts":[[2019,12,16]]}}}