Pain Control After Cesarean Birth – What are the Options?

Abstract

Cesarean sections are being performed more frequently nowadays. In most cases, it is also the first visit to the operating room for the woman, with its associated anxieties and apprehensions. The young age and female gender, in addition, make them more vulnerable to pain. Also, new mothers cannot afford the luxury of prolonged convalescence. They are expected to actively take care of the new born. Because pregnancy is a risk factor for thromboembolic phenomena, early mobilization after delivery is recommended. Good pain relief is required for this. All of these have contributed to the search for newer and more effective methods of pain control after cesarean birth. The conventional methods of analgesia have centered on the use of opioids given via diverse routes like systemic and neuraxial. Patient-controlled analgesia with elastomeric pumps has made this more acceptable and satisfying to the patients. However, opioids have some unwanted effects like pruritus and respiratory depression. In addition, secretion into breast milk is a unique concern in this population. Drugs like Non-Steroidal Anti Inflammatory Drugs (NSAID) and paracetamol can only supplement other modes of analgesia and are not sufficient on their own. Neuraxial methods, though effective and safe, need to be performed by an experienced person and require a higher level of monitoring. Regional field blocks like Transversus Abdominis Plane (TAP) block and iliohypogastricilioinguinal nerve blocks are gaining in popularity, especially after the advent of ultrasound in anesthesia. Wound infiltration catheters are also in vogue.

Relative efficacy of ultrasound-guided ilioinguinal-iliohypogastric nerve block versus transverse abdominis plane block for postoperative analgesia following lower segment cesarean section: A prospective, randomized observer-blinded trial

“…Still, we resorted to these two techniques to compare each other as they have established efficacy with proven safety. [ 20 21 ]…”

Comparison of local wound infiltration with ropivacaine alone or ropivacaine plus dexmedetomidine for postoperative pain relief after lower segment cesarean section

“…Neuraxial blocks, peripheral nerve blocks, nonsteroidal anti-inflammatory drugs (NSAIDs), and local anesthetic infiltration of wound have all been used as a part of multimodal approach. [ 3 ]…”

Analgesic Efficacy of Bilateral Ilioinguinal and Iliohypogastric Nerve Block for Post Caesarean Delivery Under Spinal Anaesthesia, 2016. Double blind randomized Study

“…However, opioids in both routes are commonly associated with side effects such as nausea, vomiting, sedation, itching, risk of delayed maternal respiratory depression, delayed initiation of breastfeeding and impairment of mother-infant bonding [2][3][4]8]. In addition, there is also inadequate supply of opioids particularly in resource limited settings, lack of patient monitoring equipments such as pulseoximetry and lack of skill of care givers in the postoperative period [9].…”