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Getamesay Demelash,1 Yophtahe Woldegerima Berhe,2 Amare Hailekiros Gebregzi,2 Wubie Birlie Chekol2 1Department of Anesthesia, College of Medicine and Health Sciences, Debre-Markos University, Debre-Markos, Ethiopia; 2Department of Anesthesia, College of Medicine and Health Sciences, University of Gondar, Gondar, EthiopiaCorrespondence: Yophtahe Woldegerima BerheDepartment of Anesthesia, College of Medicine and Health Sciences, University of Gondar, Postal Address: 196, EthiopiaTel +251-912-494282Email yophtii@gmail.comBackground: Cesarean section is the commonest obstetric procedure worldwide and pain is the leading compliant during the postoperative period. The objective of this study was to assess the prevalence and factors associated with postoperative pain after cesarean section at a University Hospital in Northwest Ethiopia.Materials and Methods: A prospective observational study was conducted among parturients who underwent cesarean section. After obtaining ethical approval, 299 parturients were approached. The numerical rating scale was used to measure pain severity. The association between variables was determined at 95% CI with binary logistic regression. A p-value < 0.05 was considered significant.Results: A total of 290 parturients were included with a response rate of 97%. The overall prevalence of moderate to severe postoperative pain after a cesarean section was 85.5% (95% CI: 81.4– 89.0%) within the first 24 postoperative hours. On the multi-variable analysis, preoperative anxiety (AOR: 2.3, 95% CI: 1.1– 4.9), history of previous cesarean section (AOR: 2.3, 95% CI: 1.1– 5.0), Pfannenstiel incision (AOR: 3.2, 95% CI: 1.3– 8.0) and absence of regional analgesia (AOR: 3.7, 95% CI: 1.7– 7.9) were significantly associated with moderate to severe postoperative pain after cesarean section.Conclusion: The prevalence of moderate to severe pain in the first postoperative day was unacceptably very high. Parturients who had preoperative anxiety, history of previous cesarean section, Pfannenstiel incisions, and those who did not receive regional analgesia have significantly suffered from postoperative pain. Pain severity needs to be assessed and documented by using pain-rating scales and interdisciplinary pain management should be provided.Keywords: pain, post-cesarean section pain, postoperative pain, cesarean section, obstetric anesthesia and analgesia