BackgroundOral analgesia is a convenient and widely used form of pain relief following caesarean section. It includes various medications used at different doses alone or in adjunction to other form of analgesia. ObjectivesTo determine the effectiveness, safety and cost-effectiveness of oral analgesia for post-caesarean pain relief. Search methodsWe searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 July 2014) and reference lists of retrieved studies. Selection criteriaRandomised controlled trials (RCTs). Cluster-randomised trials were eligible for inclusion but none were identified. Quasi-randomised and cross-over trials were not eligible for inclusion.Interventions included oral medication given to women for post-caesarean pain relief compared with oral medication, or placebo/no treatment. Data collection and analysisTwo review authors independently assessed for inclusion all the potential studies and independently assessed trial quality, extracted the data using the agreed data extraction form, and checked them for accuracy. Main resultsEight small trials involving 962 women (out of 13 included trials) contributed data to the analysis, of which only four trials had low risk of bias.None of the included studies reported on 'adequate pain relief ', which is one of this review's primary outcomes. Opiod analgesics versus placeboBased on one trial involving 120 women, the effect of opioids versus placebo was not significant in relation to the need for additional pain relief (primary outcome) (risk ratio (RR) 0.33, 95% confidence interval (CI) 0.06 to 1.92), and the effect in terms of adverse drug effects outcomes was also uncertain (RR 6.58, 95% CI 0.38 to 113.96).
To determine the effectiveness (adequate pain relief as reported by the woman, or by determination of more than 50% relief of pain (either stated by the woman or calculated using a formula), or the need for additional pain relief with a different drug, re-admission due to incisional pain, incisional pain at six weeks after surgery), safety (e.g. adverse effects of drugs, effect on breastfeeding, depression, mother and child interaction) and cost-effectiveness of oral analgesics for relieving post-caesarean pain.
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