The Analgesic Efficacy of Nonsteroidal Anti-Inflammatory Agents (NSAIDs) in Patients Undergoing Cesarean Deliveries: A Meta-Analysis

Abstract

(Reg Anesth Pain Med. 2016;41(6):763–772) In 2007, there were 1.4 million cesarean deliveries (1 in 3 live births) in the United States alone. Pain after cesarean delivery can be severe in many patients, with 78% of women undergoing cesarean delivery reporting moderate to severe postoperative pain within the first 24 hours postoperatively. Nonsteroidal anti-inflammatory drugs (NSAIDs) are effective in the treatment of this postoperative pain despite them being generally viewed as “weak” analgesics. This meta-analysis was conducted to assess the analgesic efficacy of NSAIDs in postoperative cesarean delivery patients as well as secondary outcomes such as opioid-related adverse side effects and quality of breastfeeding.

Gestational Diabetes and Intraoperative Tubal Sterilization are Risk Factors for Pain After Cesarean Delivery: A Prospective Observational Study.

“…Although many studies have concluded that uterine involution causes pain after delivery [20,21], we did not nd that the usage of more than one uterotonic agent promoting additional uterine contraction affected pain. A systematic review showed that the NSAIDs used were better than a placebo and paracetamol for the relief of pain arising from uterine cramping [20].…”

“…A systematic review showed that the NSAIDs used were better than a placebo and paracetamol for the relief of pain arising from uterine cramping [20]. Furthermore, NSAIDs have been reported to have an opioid-sparing effect after cesarean delivery [21]. Nevertheless, our study failed to demonstrate the effects of NSAIDs on postcesarean section pain.…”

“…There are two components of postcesarean delivery pain. The rst relates to the somatic pain derived from the skin incision together with the visceral pain arising from the peritoneum; the second component involves the cramping that arises from uterine involution after delivery [2,12,20,21]. We assumed the surgical incision type or the skill level of the surgeon performing the cesarean delivery (for instance, a trainee versus a graduated obstetrician) would in uence the degree of skin and soft tissue trauma and hence the postoperative pain level.…”

Evaluation of inpatient postpartum recovery using the Obstetric Quality of Recovery-10 patient-reported outcome measure: a single-center observational study

“…An American College of Obstetricians and Gynecologists committee opinion summary, 11 in addition to a consensus statement from the Society of Obstetric Anesthesia and Perinatology 12 and Enhanced Recovery After Surgery Society guidelines, 13e15 has published recommendations that address some of the poorly performing ObsQoR-10 items identified in this study, such as pain associated with cesarean delivery. These recommendations endorse the evidence-based use of long-acting intrathecal opioids, 16 regular acetaminophen, 17 and nonsteroidal antiinflammatory drugs 18 as part of a multimodal analgesia regimen aiming to reduce the need for systemic or parenteral opioids in the postpartum period. Despite the study institution adhering to these recommendations, pain was still consistently the worst…”

Predicting Opioid Use Following Discharge After Cesarean Delivery

“…Multiple studies have shown the opioid-sparing effects of these agents independently. [35][36][37] Further studies have even shown additional analgesic effects when acetaminophen and NSAIDs are combined. 38,39 In our cohort, patients received combination pills containing both an opioid and acetaminophen 81% of the time, as opposed to opioid-only pills.…”