Length of incision may affect pain after caesarean delivery

Both short and long surgical incisions for caesarean births are associated with increased pain after delivery, suggests a study. Based on the findings, the authors recommend an optimal range for caesarean incision length to be between 12 and 17 centimetres (about 4.5 – 6.5 inches), and advise that neither shorter nor longer incisions be performed when possible.
“To our knowledge, this ‘Goldilocks effect’ of surgical incision length on pain outcomes has not been previously reported, and merits further investigation to unravel the effects of short-term tissue stretch and increased tissue trauma on acute and chronic post-caesarean pain,” said lead researcher Ruth Landau, M.D., associate director of obstetric anaesthesia and director of the Center for Precision Medicine in Anesthesiology at Columbia University Medical Center in New York. “We were surprised to find tremendous variability in surgical incision length. While the median length was 15 centimetres, the range was from 9 to 23 centimetres, which may in part be due to the surgeons’ practice and patients’ body characteristics.”
The study included 690 women undergoing elective caesarean delivery, of which 37 percent had a repeat caesarean, who were evaluated pre-operatively and followed for up to 12 months. Both the shorter and longer extremes of surgical incision length were associated with increased pain. Women with shorter incisions (less than 12 cm or about 4.5 inches) were more likely to report higher pain scores immediately after delivery, which, according to the authors, likely indicates intense tissue stretching during delivery. Women with longer incisions (more than 17 cm or about 6.5 inches) were also more likely to report higher pain scores, including wound hyperalgesia, or an increased sensitivity to pain around the surgical incision. 
Consistent with the researchers’ previous work, chronic pain after caesarean delivery was extremely rare, with less than 3 percent of women reporting chronic pain one year after their caesarean delivery. Among those who underwent a repeat caesarean, chronic pain was reported by 12 of them, compared to seven of the women who had a caesarean for the first time (4.7 percent vs 1.6 percent). Overall at one year, surgical-related pain symptoms, mostly described as “tender pain,” were reported by 4.7 percent of women, and neuropathic symptoms such as itching, tingling or numbing were reported by 19 percent.
American Society of Anesthesiologists (ASA)