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Daryl Jian An Tan,1 Rehena Sultana,2 Sheryl Yu Xuan Chow,3 Chin Wen Tan,1,4 Hon Sen Tan,1,4 Helen Yu Chen,5,6 Tze-Ern Chua,5,6 Ban Leong Sng1,4 1Department of Women’s Anesthesia, KK Women’s and Children’s Hospital, Singapore, Singapore; 2Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore, Singapore; 3Duke-NUS Medical School, Singapore, Singapore; 4Anaesthesiology and Perioperative Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore; 5Department of Psychological Medicine, KK Women’s and Children’s Hospital, Singapore, Singapore; 6Paediatrics Academic Clinical Program, Duke-NUS Medical School, Singapore, SingaporeCorrespondence: Chin Wen Tan, Department of Women’s Anesthesia, KK Women’s and Children’s Hospital, 100 Bukit Timah Road, Singapore, Singapore, Tel +65 6394 6486, Fax +65 62912661, Email tan.chin.wen@kkh.com.sgPurpose: This study aimed to validate a proposed association model previously published to determine the clinical relevance of pre-operative determinants in the development of PND after Cesarean delivery (CD).Patients and Methods: Parturients undergoing elective CD under neuraxial anesthesia were recruited for a prospective cohort study between Oct 2021 and Oct 2022 at KK Women’s and Children’s Hospital, Singapore. Predelivery pain, psychological and mechanical temporal summation, and demographic data were recorded. A follow-up survey was conducted at 6 to 10 weeks after CD. The primary outcome was the incidence of PND, defined as an Edinburgh Postnatal Depression Scale (EPDS) score ≥ 10.Results: A total of 180 patients were recruited for validation. PND 6 to 10 weeks post-delivery occurred in 18.9% of recruited parturients. Multivariate regression analyses showed that higher pre-operative CSI scores (p=0.0156), higher anxiety levels about upcoming surgery (p=0.0429), increased pre-operative pain scores on movement (p=0.0110), and higher pre-operative HADS subscale scores on anxiety (

Semra Ozdemir,1– 3 Teresa Chen,4 Chin Wen Tan,4,5 Wei Han Melvin Wong,1,2 Hon Sen Tan,4,5 Eric Andrew Finkelstein,1– 3,6 Ban Leong Sng4,5 1Health Services and Systems Research, Duke-NUS Medical School, Singapore; 2Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore; 3Saw Swee Hock School of Public Health, National University of Singapore, Singapore; 4Duke-NUS Medical School, Singapore; 5Department of Women’s Anesthesia, KK Women’s and Children’s Hospital, Singapore; 6Duke University Global Health Institute, Duke University, Durham, NC, USACorrespondence: Semra Ozdemir, Duke-NUS Medical School, 8 College Road, 169857, Singapore, Tel +65 6601 3575, Email semra.ozdemir@duke-nus.edu.sgObjective: The objective was to investigate the extent to which treatment benefits, risks and costs affected parturients’ preferences for labor analgesia.Methods: We recruited 248 healthy parturients prior to labor at an antenatal ward and administered a discrete choice experiment survey. Parturients were asked to choose among four hypothetical forms of labor analgesia: epidural analgesia, pethidine, Entonox and no analgesia, which were defined by: pain score, duration of second stage of labor, risks of instrumental delivery, back pain and permanent nerve injury, and out-of-pocket cost. We used mixed logit model to calculate the relative importance of each attribute (out of 100).Results: Parturients preferred receiving labor analgesia over not receiving analgesia and those who had positive past experience with epidural preferred epidural over other modalities. Out-of-pocket cost (28%), duration of second stage of labor (26%) and pain score following treatment (18%) were the most important attributes.Conclusion: Out-of-pocket cost was a major concern. Parturients prioritized having lower pain and shorter labor experience over risks associated with epidural analgesia. Parturients should be presented with realistic range of risks of side-effects so that they can de

Xiu Ling Jacqueline Sim,1 Chin Wen Tan,2,3 Cheng Teng Yeam,4 Hon Sen Tan,2,3 Rehena Sultana,5 Ban Leong Sng2,3 1Department of Anesthesiology, Singapore General Hospital, Singapore, Singapore; 2Department of Women’s Anesthesia, KK Women’s and Children’s Hospital, Singapore, Singapore; 3Anesthesiology and Perioperative Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore; 4MOH Holdings, Singapore, Singapore; 5Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore, SingaporeCorrespondence: Ban Leong Sng Tel +65 6394 1081Fax +65 6291 2661Email sng.ban.leong@singhealth.com.sgBackground: Labor pain is a variable and complex experience with both sensory and affective components. Pain catastrophizing tendencies are predictive of increased distress during labor. Likewise, pain severity has important associations with increased depressive symptoms in mothers, with consequences on perinatal and infant outcomes. Hence, we investigated the association between increased early labor pain with both pre-delivery pain catastrophizing and depressive states.Methods: We recruited nulliparous women who had requested labor epidural analgesia. Pre-delivery questionnaires including short-form McGill pain questionnaire– 2 (SF-MPQ-2), pain catastrophizing scale (PCS), and Edinburgh postnatal depression score (EPDS) were administered.Results: A total of 712 women completed the pre-delivery questionnaires. There was a significant association between SF-MPQ-2 neuropathic subscale and EPDS ≥ 10 (unadjusted OR 1.74, 95% CI 1.11– 2.73, p = 0.0161), as well as PCS ≥ 25 (unadjusted OR 1.55, 95% CI 1.06– 2.26, p = 0.0244). SF-MPQ-2 sensory intermittent subscale and EPDS ≥ 10 (unadjusted OR 2.02, 95% CI 1.34– 3.03, p = 0.0007), and PCS ≥ 25 (unadjusted OR 1.59, 95% CI 1.14– 2.23, p = 0.0069) also showed significant association.Conclusion: Increased sensory intermittent and neuropathic subsets of early labor pain are significantly correl

Chin Wen Tan,1,2 Hon Sen Tan,1,2 Rehena Sultana,3 Anne Chui,4 Tze-Ern Chua,5,6 Helen Chen,5,6 Ban Leong Sng1,2 1Department of Women’s Anesthesia, KK Women’s and Children’s Hospital, Singapore; 2Anesthesiology and Perioperative Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore; 3Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore; 4Lee Kong Chian School of Medicine, Singapore; 5Department of Psychological Medicine, KK Women’s and Children’s Hospital, Singapore; 6Pediatrics Academic Clinical Program, Duke-NUS Medical School, SingaporeCorrespondence: Ban Leong Sng Tel +65 6394 1081Fax +65 62912661Email sng.ban.leong@singhealth.com.sgPurpose: There is limited knowledge on the relationship between postnatal depression and childbirth pain characteristics associated with childbirth. We investigated whether the characteristics of childbirth pain, as assessed by Short-form-McGill Pain Questionnaire-2 (SF-MPQ-2), were associated with postnatal anxiety and depressive disorders.Patients and Methods: Nulliparous parturients who received labor epidural analgesia (LEA) and delivered in our institution were invited to have a Mini-International Neuropsychiatric Interview (MINI) assessment following their 5– 9 weeks post-delivery follow-up phone survey of a larger study. Parturients’ demographics, pre-delivery questionnaires on pain and psychological vulnerabilities, LEA data, maternal and neonatal outcomes, postnatal follow-up survey on pain and psychological vulnerabilities, pain and breastfeeding were collected accordingly. The primary outcome was the binary variable (yes/no) of the presence of postnatal depression and/or anxiety disorders based on the post-delivery MINI assessment.Results: Among the 107 parturients who participated in the post-delivery MINI assessment, a total of 40 (42.5%) patients were found to have postnatal anxiety and depressive disorders. A greater pre-delivery SF-MPQ-2 neuropathic pain mean subscale score

Jason Ju In Chan,1 Chin Wen Tan,1,2 Cheng Teng Yeam,2 Rehena Sultana,3 Alex Tiong Heng Sia,1,2 Ashraf Samir Habib,4 Ban Leong Sng1,2 1Department of Women’s Anesthesia, KK Women’s and Children’s Hospital, Singapore; 2Anesthesiology and Perioperative Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore; 3Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore; 4Department of Anesthesiology, Duke University, Durham, NC, USACorrespondence: Ban Leong SngDepartment of Women’s Anesthesia, KK Women’s and Children’s Hospital, 100 Bukit Timah Road, 229899, SingaporeTel +65 6394 1081Fax +65 62912661Email sng.ban.leong@singhealth.com.sgBackground: Although cesarean delivery is one of the most commonly performed surgical procedures, robust data regarding post-cesarean pain is still lacking. Recent studies showed an association between pain upon local anesthetic (LA) injection for spinal anesthesia, or the use of a “three simple questions”, and acute post-cesarean pain. Nevertheless, these assessments have yet to be validated further, despite their relative ease of use. We aimed to assess the association between pain score upon LA injection with acute post-cesarean pain after 24 hours at rest (primary outcome) and sub-acute post-cesarean pain lasting for 4 weeks or more (secondary outcome).Methods: Women undergoing cesarean delivery under spinal anesthesia were given pre-operative questionnaires on pain and psychological vulnerability. We also assessed the pain score upon LA injection and mechanical temporal summation. Univariate and multivariable logistic regressions were performed.Results: The incidence of moderate-to-severe acute post-cesarean pain at 24 hours was 21.0% (95% CI=16.6– 27.6%) (48 of 217 patients). Pain score upon LA injection was not significantly associated with acute post-cesarean pain after 24 hours at rest (unadjusted OR=1.10, 95% CI=0.95&

Yanzhi Zeng,1 Chin Wen Tan,1,2 Rehena Sultana,3 Tze-Ern Chua,4,5 Helen Yu Chen,4,5 Alex Tiong Heng Sia,1,2 Ban Leong Sng1,2 1Department of Women’s Anaesthesia, KK Women’s and Children’s Hospital, Singapore; 2Anaesthesiology and Perioperative Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore; 3Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore; 4Department of Psychological Medicine, KK Women’s and Children’s Hospital, Singapore; 5Paediatrics Academic Clinical Program, Duke-NUS Medical School, SingaporeCorrespondence: Ban Leong Sng Tel +65 6394 1081Fax +65 62912661Email sng.ban.leong@singhealth.com.sgPurpose: Postnatal depression (PND) is associated with maternal morbidity and socioeconomic burden. Recent studies have shown an association between pain catastrophizing, increased labor pain, and subsequent adverse postnatal adjustment; however, little is known on its role in PND development. We aimed to investigate the association between pain catastrophizing and probable PND.Methods: Parturients planning to undergo epidural labor analgesia were recruited. Predelivery questionnaires, including the Pain Catastrophizing Scale (PCS) and Edinburgh Postnatal Depression Scale (EPDS), were administered during early labor. A phone survey at 5– 9 weeks postdelivery was conducted to determine postdelivery EPDS and Spielberger’s State–Trait–Anxiety Inventory scores. The primary outcome was a binary variable of postdelivery EPDS with cutoff of ≥ 10, whereas the secondary outcome was a continuous variable on increases in EPDS score.Results: Probable PND (EPDS ≥ 10) occurred in 10.5% (95% CI 8.0%– 13.5%, 55 of 525) of women who underwent epidural labor analgesia. We found that high pain catastrophizing (PCS ≥ 25) was associated with increased postdelivery EPDS scores (adjusted β estimate 0.36, 95% CI 0.15– 0

Carolyn Li-Jen Chan,1,* Chin Wen Tan,1,2,* Jason Ju In Chan,1 Rehena Sultana,3 Tze-Ern Chua,4,5 Helen Yu Chen,4,5 Alex Tiong Heng Sia,1,2 Ban Leong Sng1,2 1Department of Women’s Anesthesia, KK Women’s and Children’s Hospital, Singapore; 2Anesthesiology and Perioperative Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore; 3Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore; 4Department of Psychological Medicine, KK Women’s and Children’s Hospital, Singapore; 5Pediatrics Academic Clinical Program, Duke-NUS Medical School, Singapore*These authors contributed equally to this workCorrespondence: Ban Leong Sng Tel +65 6394 1081Fax +65 62912661Email sng.ban.leong@singhealth.com.sgPurpose: Pre-operative association factors (pain and psychological vulnerability) could significantly contribute to post-Cesarean pain; however, limited information is available on the development of postnatal depression (PND). We aimed to investigate the development of PND and its association with pain vulnerability and psychological vulnerability factors.Patients and Methods: Women undergoing Cesarean delivery under spinal anesthesia were given pre-operative questionnaires, psychological and pain assessments including pain on local anesthetic injection during spinal anesthesia and mechanical temporal summation. Post-operative assessments were administered at 6 to 10 weeks post-Cesarean delivery via follow-up survey to assess post-Cesarean psychological and pain outcomes.Results: PND occurred in 21.1% (43 of 205) of patients who underwent elective Cesarean delivery. An increased pre-operative pain score with movement (Odds ratio (OR) 1.65, 95% CI 1.12– 2.44, p = 0.0110), anxiety about upcoming surgery (OR 1.02, 95% CI 1.00– 1.04, p = 0.0429), higher pre-operative Hospital Anxiety and Depression Scale (HADS) subscale on anxiety (OR 1.25, 95% CI 1.07– 1.45, p = 0.0041) and higher pr