Analgesia after cesarean section-what is new?

Heidrun Lewald, Thierry Girard

Research output: Contribution to journalReview articlepeer-review

3 Scopus citations

Abstract

Purpose of reviewCesarean section is the most frequent surgical intervention, and pain following cesarean delivery unfortunately remains a common issue. The purpose of this article is to highlight the most effective and efficient options for postcesarean analgesia and to summarize current guidelines.Recent findingsThe most effective form of postoperative analgesia is through neuraxial morphine. With adequate dosing, clinically relevant respiratory depression is extremely rare. It is important to identify women with increased risk of respiratory depression, as they might require more intensive postoperative monitoring. If neuraxial morphine cannot be used, abdominal wall block or surgical wound infiltration are very valuable alternatives. A multimodal regimen with intraoperative intravenous dexamethasone, fixed doses of paracetamol/acetaminophen, and nonsteroidal anti-inflammatory drugs reduce postcesarean opioid use. As the use of postoperative lumbar epidural analgesia impairs mobilization, double epidural catheters with lower thoracic epidural analgesia are a possible alternative.SummaryAdequate analgesia following cesarean delivery is still underused. Simple measures, such as multimodal analgesia regimens should be standardized according to institutional circumstances and defined as part of a treatment plan. Neuraxial morphine should be used whenever possible. If it cannot be used, abdominal wall blocks or surgical wound infiltration are good alternatives.

Original languageEnglish
Pages (from-to)288-292
Number of pages5
JournalCurrent opinion in anaesthesiology
Volume36
Issue number3
DOIs
StatePublished - 1 Jun 2023
Externally publishedYes

Keywords

  • enhanced recovery
  • intrathecal morphine
  • prospect
  • respiratory depression

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