Transcutaneous Auricular Vagus Nerve Stimulation for Postpartum Contraction Pain During Elective Cesarean Delivery: A Randomized Clinical Trial.

Summary

In a single-center randomized, sham-controlled trial of 156 women undergoing elective cesarean delivery under combined spinal-epidural anesthesia, taVNS reduced moderate-to-severe uterine contraction pain on postoperative day 3 (5.1% vs 28.2%; RR 0.18) and improved incision pain, depression, anxiety, recovery quality, and sleep. Analyses followed intention-to-treat.

Key Findings

• Incidence of moderate-to-severe uterine contraction pain on postoperative day 3: 5.1% with taVNS vs 28.2% with sham (RR 0.18, 95% CI 0.07-0.50; P < .001).
• Lower incision pain on day 3 (median VAS 2.20 vs 3.00) and improved sleep on day 2 (LSEQ 52.00 vs 47.50).
• Reduced depression (EPDS) and anxiety (PRAQ-R2) and higher recovery quality (ObsQoR-11 104 vs 99) with taVNS.

Clinical Implications

taVNS could be incorporated as an adjunct to standard postoperative analgesia after cesarean delivery to reduce uterine contraction pain and improve recovery metrics, with minimal safety concerns. Implementation would require training and device availability.

Limitations

• Single-center study with short follow-up limited to early postoperative period
• Generalizability across diverse settings and long-term outcomes not assessed

Future Directions

Multicenter trials with longer follow-up should assess sustainability, safety, and opioid-sparing effects, and explore dosing parameters and subgroups (e.g., multiparity, breastfeeding).