Delphi study to develop a core outcome set for inpatient pain assessment after cesarean delivery

Authors

S Ciechanowicz, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, United States. Electronic address: sjciech@gmail.com.
B Carvalho, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, United States.
J Berger, Department of Anesthesiology and Critical Care Medicine, The George Washington University School of Medicine and Health Sciences, Washington, DC, United States.
P Duch, Department of Anesthesia, Copenhagen University Hospital - North Zealand, Hilleroed, Denmark.
P Flood, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, United States.
R Ffrench-O'Carroll, Anaesthetic Department, Our Lady's Children's Hospital Crumlin, Dublin, Ireland.
H Sviggum, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic Hospital, Rochester, MN, United States.
S Hakimi, Faculty of Health Sciences, EGE University, Izmir, Turkey.
D Jethava, Jethava - Department of anaesthesiology at MGMC &Hospital MGMC &Hospital.
M Mieszkowski, Department of Anesthesiology and Intensive Care, School of Medicine, Collegium Medicum, University of Warmia and Mazury, Olsztyn, Poland.
A Merriam, Obstetrics, Gynecology and Reproductive Medicine, Yale School of Medicine, United States.
S Osmundson, Osmundson - Obstetrics & Gynecology in the Division of Maternal-Fetal Medicine, Vanderbilt University Medical Center, Nashville, TN, United States.
U Ituk, Unyime Ituk, MBBS, MBA, FCARSCI. Chief, Obstetrical Anesthesia Division, Clinical Professor, Department of Anesthesia Carver College of Medicine University of Iowa Health Care, United States.
J Wagner Kovacec, University Medical Centre Maribor, Intensive Care and Pain Management, Department of Anaesthesiology, Maribor, Slovenia.
P Sultan, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, United States.

Document Type

Journal Article

Publication Date

5-27-2025

Journal

Anaesthesia, critical care & pain medicine

DOI

10.1016/j.accpm.2025.101556

Keywords

Cesarean delivery; Core outcome set; Delphi; Postoperative pain

Abstract

BACKGROUND: Studies of cesarean delivery pain report different outcomes, restricting data pooling. The study aimed to develop a core outcome set for inpatient postoperative pain assessment after cesarean delivery to use for research and clinical practice, using the Delphi consensus methodology. METHODS: A scoping review identified 37 initial outcomes, with 2 additional outcomes developed from a focus group. These were rated in a two-round Delphi survey completed by the focus group consisting of authors of studies from the scoping review (n = 9), supplemented with other experts (n = 5) and patients with recent lived experience (n = 7). Scores were on a 1-5 Likert scale, 1-2 being 'critical for inclusion'; 3 being 'important but not critical', and 4-5 of 'limited importance/invalid'. Outcomes were included if recommended by ≥70% of stakeholders after voting. A third-round virtual meeting determined domains, and several further rounds of online surveys, the specific measures. RESULTS: Round one included 14 experts and 7 patients. Round two included 12 experts and 4 patients (76% response). The virtual meeting was attended by 11 experts and 3 patients (67%), and the 4 online surveys were completed by 67%, 52%, 67%, and 76% of the focus group. The final domains included pain intensity: at rest, movement-evoked, and pain relief; pain interference; total consumption of opioids; and maternal adverse effects. 12 measures for domains were agreed upon. CONCLUSIONS: Getting out of a hospital bed was selected as the most relevant functional activity for movement-evoked pain after cesarean delivery. This core outcome set may be applied to future research and clinical practice.

APA Citation

Ciechanowicz, S; Carvalho, B; Berger, J; Duch, P; Flood, P; Ffrench-O'Carroll, R; Sviggum, H; Hakimi, S; Jethava, D; Mieszkowski, M; Merriam, A; Osmundson, S; Ituk, U; Wagner Kovacec, J; and Sultan, P, "Delphi study to develop a core outcome set for inpatient pain assessment after cesarean delivery" (2025). GW Authored Works. Paper 7201.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/7201

Department

Anesthesiology and Critical Care Medicine