Modern methods of regional and postoperative anesthesia during cesarean section: a literature review

Abstract

The number of cesarean section (CS) deliveries increases annually in Russia. General anesthesia involves certain risks, including difficult or unsuccessful intubation, aspiration, and infectious and thromboembolic complications. Therefore, regional anesthesia is the method of choice for CS. To date, choosing the most effective method of regional anesthesia remains challenging, including in the postoperative period. Thus, this review aimed to compare the effectiveness of regional anesthesia methods used in CS and identify the most preferred ones for use in clinical practice. The authors conducted a literature search in the electronic databases PubMed (MEDLINE), eLibrary, and Google Scholar using the following keywords and their combinations in English and in Russian: «cesarean section», «neural morphine», «regional analgesia», «epidural analgesia», «peripheral nerve block», nerve block», «paravertebral block», «cesarean section», neuroaxial use of opioids», «regional analgesia», «epidural analgesia», «peripheral nerve blockade», «blockade», and «paravertebral blockade». The search results revealed 3 558 in the PubMed database, 94 in eLibrary, and 2 662 in Google Scholar. The results show that the neuroaxial administration of opioids remains the gold standard of pain relief after CS; however, information on the analgesic effectiveness of new blockades, such as anterior block of the quadratic lumbar muscle and block of the muscle straightening the spine, continues to accumulate.