Women who were 18 years of age and older and had
given birth at Dartmouth Hitchcock Medical Center in
Lebanon, New Hampshire, a tertiary care facility, were
approached for study participation between July 2007
and October 2007. Institutional Review Board approval
was granted for all study activities and a National Insti-
tutes of Health certi
fi
cate of con
fi
dentiality was
obtained.
Exclusion criteria included those who were under
18 years of age and women who were unable to pro-
vide informed consent. Initial consent was obtained on
the
fi
rst postpartum day or late in the day of delivery.
Because of logistical factors such as postpartum
exhaustion resulting in low recruitment, women were
also approached and gave consent at their 36-week
visit. Women were enrolled regardless of their planned
route of delivery. Surveys were administered and col-
lected from women during 7 days a week and irrespec-
tive of the reason for cesarean (elective, repeat,
primary, or indicated).
The surgical pain scales were the primary outcome
measure included in this prospective cohort comparison
study (6). The surgical pain scale measures have been
demonstrated to be reliable, valid, and responsive to
change, and the scales have been used in large sample
clinical trials assessing outcomes from open and laparo-
scopic hernia repair, and in evaluating a watchful waiting
approach to hernia management, among other procedures
(17
–
19). A modi
fi
ed and extended version of that surgi-
cal pain scale was used here (Appendix 1), with two
items measuring pain intensity and one item assessing
pain unpleasantness. In addition, because cesarean deliv-
eries are done in a left lateral tilt position and retraction
forces are asymmetrical and could result in increased
pain on the left side because of increased force required
to visualize internal structures, four items assessing
lateral aspects of postoperative pain were also included.
Visual analog scales (150 mm) with labeled end
points were used in this study. The scales assessed the
magnitude of pain at rest and pain with activity, the
location of the pain, the intensity of the pain during
Women who were 18 years of age and older and had
given birth at Dartmouth Hitchcock Medical Center in
Lebanon, New Hampshire, a tertiary care facility, were
approached for study participation between July 2007
and October 2007. Institutional Review Board approval
was granted for all study activities and a National Insti-
tutes of Health certi
fi
cate of con
fi
dentiality was
obtained.
Exclusion criteria included those who were under
18 years of age and women who were unable to pro-
vide informed consent. Initial consent was obtained on
the
fi
rst postpartum day or late in the day of delivery.
Because of logistical factors such as postpartum
exhaustion resulting in low recruitment, women were
also approached and gave consent at their 36-week
visit. Women were enrolled regardless of their planned
route of delivery. Surveys were administered and col-
lected from women during 7 days a week and irrespec-
tive of the reason for cesarean (elective, repeat,
primary, or indicated).
The surgical pain scales were the primary outcome
measure included in this prospective cohort comparison
study (6). The surgical pain scale measures have been
demonstrated to be reliable, valid, and responsive to
change, and the scales have been used in large sample
clinical trials assessing outcomes from open and laparo-
scopic hernia repair, and in evaluating a watchful waiting
approach to hernia management, among other procedures
(17
–
19). A modi
fi
ed and extended version of that surgi-
cal pain scale was used here (Appendix 1), with two
items measuring pain intensity and one item assessing
pain unpleasantness. In addition, because cesarean deliv-
eries are done in a left lateral tilt position and retraction
forces are asymmetrical and could result in increased
pain on the left side because of increased force required
to visualize internal structures, four items assessing
lateral aspects of postoperative pain were also included.
Visual analog scales (150 mm) with labeled end
points were used in this study. The scales assessed the
magnitude of pain at rest and pain with activity, the
location of the pain, the intensity of the pain during
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