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Purpose <p>While multiple factors contribute to acute post-spinal low back pain (LBP), the role of preoperative anxiety in obstetric patients remains unclear. This prospective study investigated the association between preoperative anxiety and acute post-spinal LBP following cesarean delivery (CD).</p> Methods <p>Patients undergoing elective (category 4) or non-elective (categories 2 and 3) CD under spinal anesthesia were enrolled. Preoperative anxiety was defined as an Amsterdam Preoperative Anxiety and Information Scale score ≥ 11. The primary outcome was the incidence of acute post-spinal LBP during movement at 24&#xa0;h after surgery. Based on LBP scores, patients were categorized into no-to-mild pain (Numeric Rating Scale&#xa0;[NRS]&#xa0;0–3) and moderate-to-severe pain (NRS ≥ 4). Logistic regression was used to identify risk factors for the incidence and presence of moderate-to-severe acute post-spinal LBP.</p> Results <p>Among 295 patients analyzed, 78 (26%) had preoperative anxiety. Acute post-spinal LBP during movement at 24&#xa0;h occurred in 42 patients (14%). Pre-existing LBP (odds ratio&#xa0;[OR]&#xa0;3.37, 95% confidence interval&#xa0;[CI]&#xa0;1.61–7.06; <i>P</i> = 0.001) and delayed post-delivery ambulation (OR 1.26, 95% CI 1.09–1.46; <i>P</i> = 0.002) were associated with the overall incidence of acute post-spinal LBP. Predictors of moderate-to-severe pain were preexisting LBP (OR 3.88, 95% CI 1.33–11.28; <i>P</i> = 0.013), preoperative anxiety (OR 3.50, 95% CI 1.24–9.84; <i>P</i> = 0.017), and delayed post-delivery ambulation (OR 1.47, 95% CI 1.17–1.85; <i>P</i> = 0.001).</p> Conclusion <p>Preoperative anxiety was not associated with the incidence of acute post-spinal LBP but independently predicted moderate-to-severe pain. Pre-existing LBP and delayed post-delivery ambulation were also independent predictors of moderate-to-severe acute post-spinal LBP.</p>

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Effect of preoperative anxiety on acute post-spinal low back pain after cesarean delivery: a prospective cohort study

  • 期刊论文

  • 发表日期：

    2026年7月31日

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  • Susmita Shrestha,
  • Asish Subedi,
  • Krishna Pokharel,
  • Siddhartha Koirala,
  • Yogesh Dhakal

摘要

Purpose

While multiple factors contribute to acute post-spinal low back pain (LBP), the role of preoperative anxiety in obstetric patients remains unclear. This prospective study investigated the association between preoperative anxiety and acute post-spinal LBP following cesarean delivery (CD).

Methods

Patients undergoing elective (category 4) or non-elective (categories 2 and 3) CD under spinal anesthesia were enrolled. Preoperative anxiety was defined as an Amsterdam Preoperative Anxiety and Information Scale score ≥ 11. The primary outcome was the incidence of acute post-spinal LBP during movement at 24 h after surgery. Based on LBP scores, patients were categorized into no-to-mild pain (Numeric Rating Scale [NRS] 0–3) and moderate-to-severe pain (NRS ≥ 4). Logistic regression was used to identify risk factors for the incidence and presence of moderate-to-severe acute post-spinal LBP.

Results

Among 295 patients analyzed, 78 (26%) had preoperative anxiety. Acute post-spinal LBP during movement at 24 h occurred in 42 patients (14%). Pre-existing LBP (odds ratio [OR] 3.37, 95% confidence interval [CI] 1.61–7.06; P = 0.001) and delayed post-delivery ambulation (OR 1.26, 95% CI 1.09–1.46; P = 0.002) were associated with the overall incidence of acute post-spinal LBP. Predictors of moderate-to-severe pain were preexisting LBP (OR 3.88, 95% CI 1.33–11.28; P = 0.013), preoperative anxiety (OR 3.50, 95% CI 1.24–9.84; P = 0.017), and delayed post-delivery ambulation (OR 1.47, 95% CI 1.17–1.85; P = 0.001).

Conclusion

Preoperative anxiety was not associated with the incidence of acute post-spinal LBP but independently predicted moderate-to-severe pain. Pre-existing LBP and delayed post-delivery ambulation were also independent predictors of moderate-to-severe acute post-spinal LBP.