Postoperative pain control in the parturient: new challenges in the new millennium

Abstract

In the new millennium, the horizons of modern anesthesia practice continue to expand beyond the provision of surgical anesthesia to encompass areas outside of the operating room, including preoperative evaluation, labor analgesia, postanesthesia care, critical care and acute and chronic pain management. Adequate postoperative analgesia following caesarean delivery hastens ambulation, decreases maternal morbidity, improves patient outcome, and facilitates care of the newborn. There is currently no ''gold standard'' for post-cesarean pain management. The number of options is large and the choice of the method of pain control is determined by drug availability, institutional protocols, individual preferences, available resources, and financial considerations. This article provides an overview of the currently available methods of postcesarean analgesia.

Efficacy of a single 40‐mg intravenous dose of parecoxib for postoperative pain control after elective cesarean delivery: A double‐blind randomized placebo‐controlled trial

“…In addition and given that all operations were elective, well‐planned preoperative counseling was also provided on the day before surgery. A previous study showed that preoperative patient education improved efficacy of opioid after CD . These preoperative factors reduce patient anxiety and postoperative psychological stress.…”

“…For pain control, regional anesthesia is preferable to general anesthesia due to the lower rates of maternal and neonatal morbidity . Opioids, such as morphine and its derivatives, are commonly used for pain control after CD because of their effectiveness and safety for breastfed newborns . A study conducted in 2013 confirmed that 200 mcg of intrathecal morphine is effective in controlling postoperative pain control after CD .…”

“…A study conducted in 2013 confirmed that 200 mcg of intrathecal morphine is effective in controlling postoperative pain control after CD . As their action is mainly on the central nervous system, opioids have many adverse effects, including pruritus, nausea/vomiting, ileus, constipation, sedation, and respiratory depression …”

Oral oxycodone for pain after caesarean section: A randomized comparison with nurse-administered IV morphine in a pragmatic study

“…There is a lack of guidelines for post caesarean pain management, not only in Sweden but also in many other countries, even though neuraxial blockade in combination with non-opioids has been suggested as golden standard [3,4]. Patient controlled analgesia (PCA) with morphine has also been used for postoperative pain control [5].…”

“…In spite of this, ineffective postoperative pain treatment regimens are common [2,3]. There is a lack of guidelines for post caesarean pain management, not only in Sweden but also in many other countries, even though neuraxial blockade in combination with non-opioids has been suggested as golden standard [3,4].…”