• Stephanie Weibel, Katharina Neubert, Yvonne Jelting, Winfried Meissner, Achim Wöckel, Norbert Roewer, and Peter Kranke.
• aFrom the Department of Anaesthesia and Critical Care, University Hospital of Wuerzburg, Wuerzburg (SW, KN, YJ, NR, PK), Department of Anaesthesiology and Intensive Care, Jena University Hospital, Jena (WM) and Department of Obstetrics and Gynaecology, University Hospital of Wuerzburg, Wuerzburg, Germany (AW) *Stephanie Weibel and Katharina Neubert contributed equally to the writing of this article.
• Eur J Anaesthesiol. 2016 Nov 1; 33 (11): 853-865.

BackgroundThe frequency of caesarean section has increased dramatically in recent decades. Despite this, robust data regarding the consequences of caesarean section in terms of developing chronic postsurgical pain (CPSP) are still lacking.ObjectiveThis systematic review analysed the incidence and severity of CPSP in women 3 to less than 6, 6 to less than 12, and at least 12 months after caesarean section.DesignSystematic review of prospective and retrospective observational studies and randomised controlled trials with meta-analysis.Data SourceWe searched MEDLINE to May 2015.Eligibility CriteriaWe included all studies investigating the incidence and/or severity of CPSP at least 3 months after caesarean section. The primary outcome was chronic postsurgical wound pain (CPSP 'wound'). Secondary outcomes were persistent pain in the back area, pelvic region or reported as residual pain, and severity of 'birth-related' chronic pain.ResultsMeta-analysis using the random-effects model based on 15 studies (n = 4475) reporting CPSP 'wound' at 3 to less than 6 months after caesarean section revealed an incidence of 15.4% [95% confidence interval (CI): 9.9 to 20.9%]. For 6 to less than 12 and at least 12 months after caesarean section, the incidence of CPSP 'wound' was estimated at 11.5% (95% CI: 8.1 to 15.0%, n = 3345) and 11.2% (95% CI: 7.4 to 15.0%, n = 3451), respectively. Meta-regression analysis using the publication year as predictor revealed stable CPSP 'wound' incidences at each postoperative time slot from 2002 to the present. Of those patients who reported chronic pain, 9.6% (95% CI: 0.0 to 21.0%) had severe pain, 23.5% (95% CI: 10.0 to 37.0%) had moderate pain and 49.2% (95% CI: 18.9 to 79.4%) had mild pain at 6 months.LimitationsMajor limitations are high statistical heterogeneity of the meta-analyses and inconsistencies in reporting severity of chronic 'birth-related' pain.ConclusionThis meta-analysis finds a clinically relevant incidence of CPSP 'wound' after caesarean section ranging from 15% at 3 months to 11% at 12 months or longer that has been largely stable in recent years.

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