Prospective observational study to measure the incidence of chest pain and its association with perioperative factors among parturients undergoing lower segment cesarean section with subarachnoid blocks

Background: Intraoperative chest pain is common in parturients undergoing lower segment cesarean section (LSCS) with subarachnoid block (SAB). The study aimed to quantify the incidence of intraoperative chest pain after oxytocin in patients undergoing LSCS with SAB and to find out its association with relevant factors.

Methods: Consenting parturients undergoing LSCS with SAB were recruited. Those who had any cardiac disease, altered sensorium, had the suboptimal effect of SAB, or needed the use of any other anesthetic agent or additional uterotonic were excluded. Chest pain was graded as follows: Grade 1 - Patient lifted shoulder without restlessness, Grade 2 - Patient lifted shoulder with restlessness, Grade 3 - Patient explicitly complained of chest pain, and Grade 4 - Patient complained of chest pain with desaturation or hypotension or both.

Results: Of 2086 subjects recruited, 4.84% had chest discomfort/pain. The age and the volume of bupivacaine used in SAB were comparable between the groups who had chest pain and those without. Thirty-five (34.65%), 18 (17.82%), 21 (20.8%), and 27 (26.73%) patients had Grade 1, 2, 3, and 4 chest pain/discomfort, respectively. Logistic regression analysis showed that with an increase in age by 1 unit, the odds of chest pain decreased by 1%. With an increase in parity by one, the odds of chest pain decreased by 8%, while those who did not have comorbidities had 11.7% less odds of occurrence of chest pain than those with comorbidities.

Conclusion: The study reliably measured the incidence and characteristics of chest pain/discomfort following oxytocin during LSCS under SAB and its association with relevant factors.