An evaluation of regional anesthesia complications and patient satisfaction after cesarean section



Cesarean, Regional anesthesia, Postoperative complications, Patient satisfaction


Background/Aim: In obstetric anesthesia, regional techniques are considered advantageous for maternal mortality and morbidity. Nevertheless, serious or less severe complications related to regional anesthesia may occur. This study aimed to determine the postoperative early complications and assess postoperative pain and satisfaction of the patients by conducting a postoperative survey among those operated with regional anesthesia on the day after cesarean section. Methods: All patients who underwent a cesarean section with regional anesthesia during the day within six months at our institution were considered for eligibility to participate in this cross-sectional study. On the day after the surgery, an anesthesiologist visited the patients and collected postoperative data, including demographic data and previous anesthesia experience, presence and intensity of the pain (current and from the operation until the postoperative visit), postoperative analgesia method, postoperative nausea, and vomiting (PONV), urinary catheterization, gas discharge, presence of backache, headache, shoulder pain, and initiation and the difficulties of breastfeeding. The patients were also questioned about their comfort during the operation, and their satisfaction with the anesthetic technique used. Results: A total of 729 patients participated in the survey. Postoperative pain was managed with paracetamol and non-steroidal anti-inflammatory drugs in 696 (95.5%) patients, PCEA in 25 (3.4%) patients and intravenous PCA in 8 (1.1%) patients. Six hundred and ninety-three (87.7%) patients had pain at the time of the visit and the mean VAS score of current pain intensity was 4.2 (1.7). Seven hundred and twenty-two (99.0%) patients had pain between the end of the operation until the postoperative visit and the mean VAS score of maximum pain intensity was 6.4 (2.0). The mean time until postoperative pain began was 3.7 (2.4) hours. Among all, 48.7% of the patients experienced backache, 36.9% had shoulder pain, 17.8% had postoperative nausea, 6.6% had postoperative vomiting, and 20.2% had a postpartum headache. Breastfeeding was not initiated until the first postoperative day in 87.5% of the patients and the mean time until the onset of breastfeeding was 1.9 (2.8) hours. The intraoperative comfort and satisfaction with the anesthesia method were rated as good/very good by 74.7% and 84.4% of our patients, respectively. Conclusion: Backache and shoulder pain are the most frequent minor complications in patients operated with regional anesthesia on the day after cesarean section. Determining and overcoming postoperative early complications is important for the satisfaction of patients after cesarean section.


Download data is not yet available.


Ronsmans C, Graham WJ. Lancet Maternal Survival Series steering group. Maternal mortality: who, when, where, and why. Lancet. 2006;368(9542):1189-200.

Moen V, Dahlgren N, Irestedt L. Severe neurological complications after central neuraxial blockades in Sweden 1990– 1999. Anesthesiology. 2004;101:950– 9.

Capuzzo M, Alvisi R. Is it possible to measure and improve patient satisfaction with anesthesia? Anesthesiol Clin. 2008;26:613– 26.

Saal D, Heidegger T, Nuebling M, Germann R. Does a postoperative visit increase patient satisfactionwith anaesthesia care? British Journal of Anaesthesia. 2011;107(5):703–9.

Declercq E, Cunningham D, Johnson C, Sakala C. Mothers’ reports of postpartum pain associated with vaginal and cesarean deliveries: results of a National survey. Birth. 2008;35:16–24.

Karlstro¨m A, Engstro¨m-Olofsson R, Norbergh KG, Sjo¨ling M, Hildingsson I Postoperative pain affects breastfeeding and infant care. Journal of Obstetric Gynecologic and Neonatal Nursing. 2007;36:430–40.

Sun H-L, Wu C-C, Lin M-S, Chang CF. Effects of epidural morphine and intramuscular diclofenac combination in postcesarean analgesia: a dose-range study. Anesth Analg. 1993;76:284–8.

Hsu H, Cheng Y, Chen L, Wang Y,Lin C, Lee C, Sun W. Differential Analgesic Effect of Tenoxicam on the Wound Pain and Uterine Cramping Pain After Cesarean Section. The Clinical Journal of Pain. 2003;19(1):55-8.

Aluri S, Wrench IJ. Enhanced recovery from obstetric surgery: a UK survey of practice. Int JObstet Anesth. 2014;23:157–60.

Macones GA, Caughey AB, Wood SL, et al. Guidelines for postoperative care in cesarean delivery: Enhanced Recovery After Surgery (ERAS) Society recommendations (part 3). Am J Obstet Gynecol. 2019;221:247.e1-9.

DiMatteo MR, Morton SC, Lepper HS, Damush TM, Carney MT, Pearson M, Kahn KL. Cesarean childbirth and psychosocial outcomes: a meta-analysis. Health Psychology. 1996;15:303–14.

Dewey K, Nommsen-Rivers L, Heinig J, Cohen R. Risk factors for suboptimal infant breastfeeding behavior, delayed onset of lactation and excess neonatal weight loss. Pediatrics. 2003;112:607–19.

Kutlucan L, Seker İ.S, Demiraran Y, Ersoy Ö, Karagöz İ, Sezen G, Köse SA. Effects of different anesthesia protocols on lactation in the postpartum period. J Turk Ger Gynecol Assoc. 2014;15:233-8.

Awi DD, Alikor EA. Barriers to timely initiation of breastfeeding among mothers of healthy full-term babies who deliver at the University of Port Harcourt Teaching Hospital. Niger J Clin Pract. 2006;9(1):57-64.

Jesmin E, Chowdhury RB, Begum S, Shapla NR, Shahida SM. Postnatal support strategies for improving rates of exclusive breastfeeding in case of caesarean baby. Mymensingh Med J. 2015;24(4):750-5.

Cotev S, Robin GC, Davidson JT. Back pain after epidural analgesia. Anesth Analg. 1967;46:259–63.

Brattebø G, Wisborg T, Rodt SA, Røste I. Is the pencil point spinal needle a better choice in younger patients? A comparison of 24G Sprotte with 27G Quincke needles in an unselected group of general surgical patients below 46 years of age. Acta Anaesthesiol Scand. 1995;39:535–8.

Pan PH, Fragneto R, Moore C, Ross V. Incidence of postdural puncture headache and backache, and success rate of dural puncture: comparison of two spinal needle designs. South Med J. 2004;97:359–63.

Abdullayev R, Küçükebe ÖB, Çelik B, Kirman N, Hatipoğlu HS, Hatipoğlu FA. Does Atraucan cause more postdural puncture backache? Turk J Med Sciences. 2015;45:877-81.

Tekgül ZT, Pektas S, Turan M, Karaman Y, Çakmak M, Gönüllü M. Acute Back Pain Following Surgery under Spinal Anesthesia. Pain Practice. 2015;15(8):706-11.

Zirak N, Soltani G, Hafizi L, Mashayekhi Z, Kashani I. Shoulder pain after caesarean section: comparison between general and spinal anaesthesia. J Obstet Gynaecol. 2012;32:347-9.

Abedian Z, Nikpor M, Mokhber N, Ebrahimzade S, Khani S. Evaluation of relationship between delivery mode and postpartum quality of life. Iranian J Obstet Gynaecol and Infertility. 2010;13:47-53.

Çift T, Üstünyurt E, Yılmaz C, Ölmez F, Başar B. Shoulder Tip Pain After Cesarean Section. Journal of Clinical and Diagnostic Research. 2015;9(8):QC04-6.

Elliott P, Seemungal BM, Wallis DI. Antagonism of the effects of 5-hydroxytryptamine on the rabbit isolated vagus nerve by BRL 43694 and metoclopramide. Naunyn Schmiedebergs Arch Pharmacol. 1990;341:503–9.

Mishriky BM, Habib AS. Metoclopramide for nausea and vomiting prophylaxis during and after Caesarean delivery: a systematic review and meta-analysis. British Journal of Anaesthesia. 2012;108(3):374-83.

Macarthur A. Postpartum headache. In: Chestnut DH, Polley LS, TsenLC, Wong CA, eds. Chestnut’s Obstetric Anesthesia Principles and Practice,4th Edn. Philadelphia: Mosby Elsevier, 2009; 677–80.

Goldszmidt E, Kern R, Chaput A, Macarthur A. The incidence and etiology of postpartum headaches: a prospective cohort stud. Can J Anesth. 2005;52:971–7.

Stella CL, Jodicke CD, How HY, et al. Postpartum headache: is your work-up complete? Am J Obstet Gynecol. 2007;196:318.e1–7

Myles PS, Williams DL, Hendrata M, Anderson H, Weeks AM. Patient satisfaction after anaesthesia and surgery: results of a prospective survey of 10,811 patients. British Journal of Anaesthesia. 2000;84(1):6-10.

Vahapoğlu A, Türkmen ÜA, Güngör H, Köseoğlu ÖF. Effects of spinal anaesthesia related complication and demographic distribution on patient satisfaction following caesarean section. Medicine Science. 2019 doi: 10.5455/medscience.2019.08.9048






Research Article

How to Cite

Uyar Türkyılmaz HE, Camgöz Eryılmaz N, Aydın Güzey N. An evaluation of regional anesthesia complications and patient satisfaction after cesarean section. J Surg Med [Internet]. 2021 Aug. 1 [cited 2022 Oct. 4];5(8):813-7. Available from: