Uterine Incision Discomfort
Visceral pain experienced during cesarean section despite adequate somatic anesthesia. Results from uterine manipulation and requires treatment with systemic analgesics or conversion to general anesthesia.
Full Definition
Uterine incision discomfort refers to the visceral pain that can occur during cesarean section when the uterus is manipulated, incised, or exteriorized, even in the presence of apparently adequate neuraxial anesthesia. This phenomenon occurs because visceral innervation of the uterus travels through sympathetic pathways that may not be completely blocked by standard neuraxial techniques. The discomfort is typically described as deep, aching, or nauseating pain and is distinct from the sharp, well-localized somatic pain of skin incision. Management options include intravenous opioids (fentanyl, morphine), sedation with propofol or midazolam, nitrous oxide, or conversion to general anesthesia if severe. The incidence varies but can occur in 10-30% of cesarean sections under neuraxial anesthesia.
Usage
Usage note: Avoid the term 'breakthrough pain' in this context as it has specific meanings in chronic pain management.
In Context
- "Despite a T4 sensory level, the patient experienced significant uterine incision discomfort requiring intravenous fentanyl." — Anesthesia record
- "Uterine incision discomfort is an expected occurrence that should be anticipated and managed proactively." — Resident education material