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Postoperative analgesia after caesarean delivery 

Postoperative analgesia after caesarean delivery
Chapter:
Postoperative analgesia after caesarean delivery
Author(s):

Sarah L. Armstrong

and Gary M. Stocks

DOI:
10.1093/med/9780198713333.003.0024
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date: 25 February 2020

Caesarean delivery (CD) is one of the most common operations in the world and providing effective pain relief is important not only for humanitarian reasons but also to speed up recovery and reduce postoperative complications. An understanding of the anatomy and physiology of pain transmission after CD has led to a multimodal approach to analgesia. This involves combining analgesics which work by different mechanisms resulting in an additive effect whilst at the same time reducing side effects. In contemporary practice, most CDs are carried out under neuraxial anaesthesia and neuraxial techniques using either intrathecal or epidural opioids have become central to the provision of effective postoperative analgesia. They reduce the need for systemic opioid analgesia and have few side effects, respiratory depression being the most significant but extremely uncommon. In circumstances where it is not possible to use neuraxial analgesia, for example, after general anaesthesia, other techniques such as intravenous patient-controlled analgesia using opioids and the transversus abdominis plane block have been shown to be effective. As part of the multimodal analgesic approach, many patients will require systemic analgesics to further improve pain relief and to limit side effects. Paracetamol and non-steroidal anti-inflammatory drugs are now widely established in the management of postoperative CD pain where they have been shown to potentiate opioid effects, decrease opioid consumption, reduce side effects, and complement the somatic pain relief provided by opioids. As part of a step-down approach after primary management with neuraxial or intravenous opioids, oral opioids are often required as part of a multimodal regimen.

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