Management of Pain After Cesarean Delivery Without Intrathecal Morphine: Networking for the Best Answer

Abstract

(Can J Anesth/J Can Anesth. 2020;67:1704–1709) Acute pain after cesarean delivery (CD) is a predictor of important short-term and long-term outcomes including postpartum depression. Intrathecal opioids are often provided as post-CD analgesia following CD using neuraxial analgesia. However, when spinal anesthesia or intrathecal morphine are not good options, truncal blocks and local anesthetic wound infiltration (WI) are possible alternatives. Common truncal blocks used in this context include the transversus abdominis plane (TAP) block or quadratus lumborum block (QLB). A recent network meta-analysis (NMA) by Sultan et al compared single-injection TAP block, single-dose WI and continuous wound catheter (WC) in terms of 24-hour opioid consumption. TAP block and WC showed lower opioid consumption and pain scores that WI or inactive control. TAP block also had a longer time-to-first analgesic request than inactive controls.