A cross sectional study to evaluate the anticipated and experienced pain at the site of spinal needle insertion in patients undergoing elective lower segment caesarean section

Background and Aim: Spinal anaesthesia is the preferred technique for elective lower segment cesarean section (LSCS). However, needle-phobia and anticipation of pain are significant causes of refusal. This study aimed to quantify and compare the levels of pain patients anticipate versus the pain they actually experience during spinal needle insertion for LSCS.Materials and Methods: This prospective cross-sectional study included 207 American Society of Anaesthesiologists (ASA) physical status II primigravidae scheduled for elective LSCS under spinal anaesthesia. Prior to the procedure, the Amsterdam Preoperative Anxiety and Information Scale (APAIS) was used to assess anxiety. Patients rated their anticipated pain on a Numerical Pain Rating Scale (NPRS, 0-10). After the procedure, they rated their experienced pain at the needle insertion site using the same NPRS. Spinal anaesthesia was performed in the sitting position using a standard protocol. The duration of the procedure and the number of attempts were recorded.Results: The mean anticipated pain score (5.2 ± 1.8) was significantly higher than the mean experienced pain score (2.1 ± 1.4) (p < 0.0001). APAIS anxiety scores showed a moderate positive correlation with anticipated pain (r = 0.46, p < 0.001) and a significant, though weaker, correlation with experienced pain (r = 0.41, p < 0.001). Factors associated with higher experienced pain included an APAIS score ≥11, a spinal procedure duration exceeding 10 minutes, and multiple needle insertion attempts.Conclusion: Patients undergoing elective Cesarean delivery significantly overestimate the pain they will experience from spinal needle insertion. Preoperative anxiety is a key factor influencing both anticipated and experienced pain. These findings can be used to counsel anxious patients and potentially reduce refusal rates of spinal anaesthesia.