Chronic pain common with c-section incision

Chronic pain is often seen in patients who receive a "Pfannenstiel" incision as part of a c-section or other operation, Dutch researchers report in the journal Obstetrics & Gynecology. In moderate-to-severe cases, the pain often stems from compression of nearby nerves.

The Pfannenstiel incision is a curved incision just below the bikini line. While it is often used to provide safe access for c-sections and hysterectomy, it has also been used for a number of non-gynecologic operations, including appendectomy, prostate removal, and hernia repair, the authors note. In recent years, the incision has even been used for various laparoscopic "key-hole" type operations.

Despite its popularity, there have been reports linking the incision with chronic pain. To explore this further, Dr. Maarten J. Loos and colleagues, from Maxima Medical Centre in Veldhoven, conducted a pain survey of 866 women who had a Pfannenstiel incision for a c-section or hysterectomy performed between 2003 and 2004. In-person interviews and physical examinations were performed for all patients describing moderate or severe pain.

Eighty percent of patients (690 women) responded to the survey. One third of the patients reported having chronic pain, but only 7 percent considered the pain moderate or severe. Still, 8.9 percent of respondents said that the pain impaired daily activities.

Undergoing more than one operation that used a Pfannenstiel incision, experiencing numbness, and undergoing emergency c-section were all associated with chronic pain.

Of the 32 patients with moderate-to-severe pain, 17 had evidence of nerve compression, the findings show.

"Although long-term pain after a Pfannenstiel incision has been identified in some earlier studies, the present study demonstrates the large prevalence of Pfannenstiel pain with contributing risk factors," Loos' team concludes.

SOURCE: Obstetrics and Gynecology, April 2008.