Post cesarean analgesia

Abstract

There are a variety of effective options for postcesarean analgesia. A single epidural injection of 4 mg of morphine provides 18 to 24 hours of good to excellent analgesia. A single spinal injection of 0.1 mg of morphine also provides 18 to 24 hours of analgesia. Continuous epidural catheter techniques can be effective, usually by relying on a combination of a short-acting opioid, such as fentanyl or sufentanil, and a local anesthetic, usually bupivacaine or ropivacaine. Occasionally, with this technique, motor block caused by the local anesthetic interferes with maternal ambulation. Patient-controlled techniques, either intravenous or epidural, also have proven effective. A variety of opioids (including morphine, meperidine, and fentanyl) have been used for intravenous patient-controlled analgesia with little to recommend one drug over the other. For epidural patient-controlled analgesia, opioid-local anesthetic combinations are usually used, with delivery parameters dependent on the exact concentration of the chosen solution. Regardless of the technique chosen, careful monitoring of patients in the early postoperative period (24 hours) is essential to avoid adverse effects and to ensure maternal satisfaction.