Raising awareness to prevent, recognise and manage acute pain during caesarean delivery: The French Practice Bulletin

Inadequate neuraxial anaesthesia in patients undergoing elective caesarean section: a systematic review

“…Published guidelines from the UK and USA surrounding management of pain during caesarean section are currently lacking [11]. The French Club Anesthésie Réanimation en Obstérique recently convened to provide a clinical framework and practice bulletin to prevent, recognise and treat acute pain during caesarean section [6]. Prevalence figures reported in this review can be used as a framework to inform patients, guide clinicians and develop national guidelines for optimal management of this complication.…”

“…Subspecialty organisations have thus far provided little guidance surrounding optimal management of pain during caesarean section. The French Practice Bulletin is one of the few professional societies that have raised awareness regarding this issue by providing best-practice guidance for the prevention, recognition, treatment and follow-up of insufficient or failed anaesthesia to all stakeholders involved in the care of women undergoing caesarean section under neuraxial anaesthesia [6,11]. Accurate prevalence data for inadequate neuraxial anaesthesia would be invaluable to help clinicians counsel and consent patients regarding the potential risks associated with caesarean section under neuraxial anaesthesia, to facilitate development of optimal management strategies for this complication and to help direct future research efforts in this area.…”

“…Neuraxial anaesthesia is not always successful – the reported prevalence of inadequate or failed neuraxial anaesthesia varies widely, ranging from 0.8% to 12% [6–8]. However, the true prevalence of severe breakthrough pain during caesarean section remains unknown.…”

“You test because you cannot afford to make assumptions”

“…Defining a failed neuraxial block is challenging, with great heterogeneity existing in the definition [11,12]. The French Practice Bulletin provides a new succinct definition of a failed block as any circumstance when, under neuraxial anaesthesia, the patient requests additional medication [6]. Plaat et al sensibly question how much the actual definition matters [5].…”

“…aim to improve care by providing a common framework for preventing intra‐operative pain during neuraxial anaesthesia, managing it should it occur and ensuring follow‐up is in place when it has happened [5]. Publication of these guidelines coincides with the publication of the French Practice Bulletin framework which reinforces a similar message [6, 7].…”