OAA Project Grant
Oxford Persisting Post-Operative Pain Study: the incidence and contributing factors of persisting pain one year after caesarean section
Dr Nicola Beale
Many patients experience pain in the days following surgery. This can usually be effectively managed with simple pain killers. It is now appreciated, however, that some patients continue to have pain for many months. Pain is a complicated process and many factors affect how much and for how long pain is perceived. These factors include those inherently related to the patient, the type of anaesthetic and surgical technique used, and the way that pain relief is managed in the days following surgery. One in four women now gives birth by caesarean section which is one of the most frequently performed operations in the UK. It has been suggested that at 15% of women suffer from long-term pain after surgery. This represents a large number of women experiencing problems at an important time in their lives. In this long term project we aim to study how often pain persists for one year after elective caesarean section. We shall collect data on factors that may be important in the development of pain. This information will be gathered before, during and after caesarean section, in order to identify those factors which may predict whether a woman is more likely to develop chronic pain. If women are at greater risk of developing chronic postoperative pain it might be possible to introduce interventions to minimise its impact.
Comparison of the ED95 dose of 0.075% and 0.1% bupivacaine for labour analgesia in primigravida
Professor Phil Hopkins
The epidural space runs from the neck down the middle of the back to the base of the spine. In the lower back it contains the nerves that carry pain sensation from the womb to the spinal cord and then to the brain. If local anaesthetic is injected in the epidural space it numbs these nerves and thereby relieves pain. Epidurals are the most effective method of relieving pain in labour. Anaesthetists place a small tube called an 'epidural catheter' in this space and inject local anaesthetic to achieve pain relief during labour and child birth. However, if too much local anaesthetic is taken up into the blood stream it can cause complications affecting the brain, heart and the baby. To reduce the risk of these complications, the anaesthetist aims to use the lowest dose of local anaesthetic that they think will provide pain relief for most women but to date there is no research that precisely helps with this decision. About 150,000 epidurals are performed every year in the UK for pain relief during childbirth. The aim of this clinical trial is to improve the safety of the epidurals by standardising the starting dose for pain relief during labour.