The Relationship Between Perioperative Circadian Rhythm Changes And Acute Pain After Cesarean Section And Analysis Of Related Factors

Acute pain after cesarean section is a common postoperative complication in clinical practice,and severe postoperative pain is associated with higher rates of postpartum depression,chronic pain,slower activity recovery,and poorer neonatal care.Although the surgical procedures of cesarean section are basically the same and the intensity of noxious stimulation to the body is similar,there are large individual differences in the pain after cesarean section and its lasting impact.The interaction of multiple factors,such as pregnancy,breastfeeding,and society,increases the difficulty of predicting the strength of pain after cesarean section and analgesia therapy.In recent years,studies have found that changes in sleep,humoral,and pain sensitivity brought by circadian rhythm can affect the sensitivity of pain.Related studies believe that it may affect postoperative pain,but for cesarean section,the impact and correlation of postoperative pain remain to be studied.Therefore,further understanding of the impact of perioperative circadian rhythm changes on postoperative analgesia after cesarean section is important for improving the prognosis of cesarean section patients and reducing the social disease burden.Objective To explore the relationship between changes of circadian rhythm types in the perioperative period and acute pain after cesarean section.Methods The clinical data of 148 patients who underwent cesarean section in Shunde Women’s and Children’s Hospital of Guangdong Medical University from November 2020 to September 2021 were used for a bidirectional cohort study.The patients were grouped according to the results of the morning and evening questionnaires(MEQ-SA)before delivery and 3 days after delivery.Patients with different types of questionnaire results were classified as circadian rhythm change group(exposure group),and patients with the same types were circadian rhythm unchanged group(control group).Using Logistic regression to analyze the relationship between perioperative related factors and circadian rhythm type changes.Results There were 21 people in the exposure group and 127 people in the control group.The weight and BMI of the control group were higher than those of the exposure group,and there was no significant difference in age,parity,and height.The NRS score on dayl was significantly higher than the control group’s(P<0.05).In the primipara subgroup,iatrogenic sleep interruptions in the exposure group on the night after surgery were significantly higher than that in the control group(P<0.05);perioperative-related factors such as age,height,and weight were included to construct a multivariate Logistic regression equation.The results showed that the lower the body weight(OR=0.93,95%CI 0.89-0.97,P<0.001),the more iatrogenic sleep interruptions on the night after surgery(OR=1.89,95%CI 1.09-3.27,P=0.024),The higher the pain NRS score on the 1st day after surgery(OR=2.25,95%CI 1.10-4.61,P=0.026),are related to the higher the risk of perioperative circadian rhythm changes;patients with intermediate circadian rhythms before surgery,The risk of circadian rhythm changes was lower(OR=0.12,95%CI 0.02-0.58,P=0.009).Conclusion Perioperative circadian rhythm changes are associated with increased acute pain after cesarean section,and with body weight,iatrogenic sleep interruptions,and preoperative circadian rhythm patterns,and there is significant heterogeneity between primipara and multiparous women.