Post-Cesarean Delivery Analgesia

Abstract

Post-cesarean delivery pain relief is important. Good pain relief will improve mobility and can reduce the risk of thromboembolic disease, which is increased during pregnancy. Pain may also impair the mother's ability to optimally care for her infant in the immediate postpartum period and may adversely affect early interactions between mother and infant. Pain and anxiety may also reduce the ability of a mother to breast-feed effectively. It is necessary that pain relief be safe and effective, that it not interfere with the mother's ability to move around and care for her infant, and that it result in no adverse neonatal effects in breast-feeding women. The most commonly used modalities are systemic administration of opioids, either by intramuscular injection or i.v. by patient-controlled analgesia, and neuraxial injection of opioid as part of a regional anesthetic for cesarean delivery. These techniques have specific advantages and disadvantages which will be discussed in this review. In addition, there are new drug applications of potential benefit for the treatment of post-cesarean delivery pain.

Evaluation of the effectiveness of the Quadratus Lumborum Block type I using ropivacaine in postoperative analgesia after a cesarean section — a controlled clinical study

“…Intravenous administration of opioids is recommenced, using the Patient Controlled Analgesia method (PCA) [4,8]. In the opinion of numerous authors, the most effective and longest-lasting analgesic (11-24 hours) in the postoperative period among patients after a C-section, is exhibited by morphine used as a component of spinal anesthesia [17,18].…”

“…Over the next 48 hours, all patients received 1 g of paracetamol iv at constant intervals of time (every 6 hours) and 5 mg of morphine subcutaneously depending on their intensity of pain (NRS > 3), or, on demand with the proviso of a 4-hour administration frequency. Next, the the level of pain intensity was evaluated, only in rest among the newly delivered mothers (using NRS scale 0-10 in which 0 = no pain and 10 = worst pain imaginable) and consecutively after 2,4,8,12,16,20,24,30,36, 42 and 48 hours. At every postoperative time-point the following parameters were measured: sedation (Ramsey scale); nausea, vomiting and itching (0 = none, 1 = mild, 2 = moderate, 3 = severe); the possibility of the free movement of limbs or any other possible side effects.…”

“…The intensity of postoperative acute pain among patients after a C-section results from the development of somatic and visceral pain which occurs due to cutting the structures of the abdominal wall and the uterus [2,3]. Unsuccessfully conducted analgesia after a C-section results in considerable suffering in newly delivered mothers, who consequently may be less willing to feed and care for the new-born [4,5]. Additionally, unsuccessfully conducted analgesia may impair early ambulation www.…”

Preventive Analgesia with Intravenous Paracetamol for Post-cesarean section Pain Control

“…Patients undergoing C.S may experience significant postoperative pain (1). Pain after cesarean delivery may impair the bond of affection and early interaction between mother and infant, the mother's ability to care and feed for her child, early ambulation and discharge (2). Chronic pain also is a complication of cesarean delivery.…”

Breastfeeding after Anesthesia: A Review for Anesthesia Providers Regarding the Transfer of Medications into Breast Milk

“…The bioavailability of morphine is low when taken orally and less is transmitted to the infant after hepatic metabolism in the mother. 31 An epidural infusion for post-cesarean pain relief minimizes opioid exposure. 32 A randomized study that compared spinal anesthesia for elective cesarean section with or without the use of postoperative epidural continuous bupivacaine found that the continuous group had lower pain scores and a higher volume of milk fed to their infants.…”