Postcesarean delivery analgesia

Abstract

Effective pain management should be a key priority in women undergoing cesarean delivery. Suboptimal perioperative pain management is associated with chronic pain, greater opioid use, delayed functional recovery, impaired maternal-fetal bonding, and increased postpartum depression. Severe acute postoperative pain is also strongly associated with persistent pain after cesarean delivery. Multimodal analgesia is the core principle for cesarean delivery pain management. The use of neuraxial morphine and opioid-sparing adjuncts such as scheduled nonsteroidal anti-inflammatory medications and acetaminophen is recommended for all women undergoing cesarean delivery with neuraxial anesthesia unless contraindicated. Additional analgesic and opioid-sparing options such as wound instillation of local anesthetics, transversus abdominis plane blocks, dexamethasone, gabapentin, and ketamine may be used as appropriate in women at risk of severe postoperative pain or in women whose postoperative pain is not well controlled despite standard analgesic regimes.

Transversus abdominis plane block and quadratus lumborum block did not reduce the incidence or severity of chronic postsurgical pain following cesarean section: a prospective, observational study

“…The occurrence of CPSP following cesarean section was reported by 48%, 34%, and 27% of patients at the first, third, and sixth postoperative month, respectively. In most studies, the incidence of CPSP after cesarean section rarely exceeds 18% at the sixth month [4][5][6][7][8][9]. In a study by Jin et al [17], only 18.3% and 11.3% of patients experienced CPSP three and six months after cesarean section, respectively.…”

Substance use disorders in pregnancy: clinical, ethical, and research imperatives of the opioid epidemic: a report of a joint workshop of the Society for Maternal-Fetal Medicine, American College of Obstetricians and Gynecologists, and American Society of Addiction Medicine

“…66 Although the data regarding preoperative gabapentin (600 mg) is mixed and there is some concern about transfer into breast milk and postpartum side effects such as dizziness, the risk/benefit ratio in this population may favor its use. 67 Transverse abdominus plane (TAP) blocks may also be used preoperatively or postoperatively. Although they have not been studied in opioid-dependent patients, they may have clinical utility in this population.…”

Guidelines for Management of Analgesics after Caesarean Section: Cognitive Survey

“…Caesarean delivery is correlated to acute post-operative pain and evidence shows an association with the development of chronic pain, increased use of opioids, delayed recovery of the functions and increased post-partum depression [3]. The use of multimodal analgesia, which uses a combination of different drugs with a different mechanism of action, is aimed at achieving better pain relief and minimising its side effects [4].…”