The Expectation–Experience Disparity in Pain During Spinal Needle Insertion for Elective Lower Segment Caesarean Section: A Prospective Observational Study

Abstract

Spinal anaesthesia is the preferred technique for caesarean section, but anxiety of needle pain and fear of backache may lead to refusal of needle insertion. Further, pregnant patients have elevated anxiety and anticipated pain levels. The aim of the study was to evaluate the anticipated and experienced pain at the site of spinal needle insertion in patients undergoing elective lower segment caesarean section. Other objectives included assessing the anxiety associated with pain, and the correlation of anxiety with anticipated pain. Using the Numeric Pain Rating (NPR) Scale, the anticipated pain was noted at the pre-operative stage, and experienced pain at the post-operative stage.  Anxiety before the procedure was noted using the Amsterdam Preoperative Anxiety and Information (APAI) Scale. 42.5% subjects were categorized as anxious based on the APAI scale. Significant difference was observed between the average anticipated pain score (6.3±1.2) and average experienced pain score (2.1±0.7) (p<0.05), as per the NPR scale. Statistically significant association was found between anxiety level and pain at p<0.05. A large difference between anticipated and experienced pain levels was observed, with patients overestimating the anticipated pain. Preoperative anxiety may be associated with higher anticipated pain, and higher postoperative experienced pain. Counselling and routine evaluation of pre-operative anxiety may help provide support for better acceptance and reduced anxiety.