Shoulder Tip Pain During and After Caesarean Section under Spinal Anaesthesia: Incidence, Severity, and Associated Factors in a Tertiary Hospital in Ethiopia

Background Shoulder tip pain is a frequently under-recognised complication during and after caesarean section. It can significantly affect maternal comfort, mobility, and neonatal care during the critical postpartum period. Despite its prevalence, little is known about its incidence, severity, and contributing factors in African settings. This study aimed to determine the incidence and severity of intraoperative and postoperative shoulder tip pain, and to identify associated factors in mothers undergoing elective caesarean section under spinal anaesthesia at a tertiary hospital in Ethiopia. Methods This was a prospective, cohort study conducted at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia from June 1, 2023 to May 1, 2024. A total of 165 mothers undergoing elective caesarean section under spinal anaesthesia were recruited through sequential non-random sampling. Shoulder tip pain was assessed intraoperatively and within 24 hours postoperatively using a numerical rating scale. Bivariate and multivariate logistic regression analyses were conducted to identify factors associated with shoulder tip pain, and significance was set at p < 0.05. Results Among the 165 participants, 73 (44.2%) experienced shoulder tip pain, with 24 (14.5%) reporting intraoperative pain and 64 (38.8%) reporting postoperative pain. Fifteen mothers experienced both. The right side was the most commonly affected (70.4%). Intraoperative pain was more frequently severe, while postoperative pain was predominantly moderate. In multivariate analysis, intraoperative bleeding greater than 500 mL was significantly associated with shoulder tip pain (adjusted odds ratio 4.427, 95% confidence interval 2.162–9.064; p < 0.01). No significant associations were found with age, BMI, gravidity, sensory level, or duration of surgery. Conclusion The incidence of shoulder tip pain during and after caesarean section under spinal anaesthesia is high and clinically significant. The pain is frequently moderate to severe, predominantly right-sided, and associated with greater intraoperative blood loss. Routine assessment and management of shoulder tip pain should be integrated into perioperative care. Further research, particularly randomised controlled trials, is needed to explore preventive strategies and the impact of anaesthetic and surgical techniques.