Post-operative Emesis and Pain Outcomes After Cesarean Delivery
Post-operative Emesis and Pain Outcomes After Cesarean Delivery
Approximately 20% women who undergo cesarean delivery would suffer from severe post-operative
 pain, which may further increase their risks from developing postpartum depression.
 Predictive factors such as pre-operative pain, age and anxiety could significantly contribute
 to post-operative nausea and vomiting (PONV) and pain in general surgery, however little
 information is available with regards to cesarean delivery. The investigators would
 investigate the risk factors of causing post-operative emesis after cesarean delivery, and to
 reaffirm that there is a positive correlation between pain on local anesthetic injection,
 presence of mechanical temporal summation (MTS) and post-Cesarean pain scores.
Previous studies demonstrated that pain scores upon local anesthetic injection is positively
 correlated to post-cesarean pain scores. Anxiety, anticipated post-operative pain score and
 anticipated medication need are also found to be promising risk factors to post-cesarean pain
 management.

 The investigators would investigate the risk factors of causing post-cesarean emesis, and to
 reaffirm that there is a positive correlation between pain on local anesthetic injection,
 presence of mechanical temporal summation (MTS) and post-Cesarean pain scores. 470
 parturients undergoing cesarean delivery and requiring regional anaesthesia will be
 recruited. Pain and anxiety assessment will be conducted via visual analogue scoring (VAS),
 MTS assessment and a series of questionnaires. After delivery, patients will be given
 appropriate analgesia, and pain score at movement will be recorded. Secondary outcomes
 include pain scores at rest, analgesia consumption, time-to-first-rescue analgesia,
 opioid-related side effects, patient satisfaction and postpartum depression. A separate 125
 patients will be recruited to evaluate the feasibility and patient acceptability of the use
 of Headspace, a mindfulness mobile application during the pre- and postnatal period to
 improve the maternal outcomes (emesis, pain, anxiety, depression).
Inclusion Criteria:

 -  Pregnant and going to have caesarean delivery (36 weeks gestation or more; nulliparous
 and multiparous);

 -  Healthy or have mild medical problems that are well-controlled (American Society of
 Anesthesiologists physical status 1-2).

 Exclusion Criteria:

 -  History of intravenous drug or opioid abuse;

 -  Previous history of chronic pain syndrome;

 -  Emergency cesarean section;

 -  Undergo general anaesthesia during cesarean delivery;

 -  Non-English speaking.