Postcesarean Section Pain Prevention and Relief

Abstract

Summary In this young and healthy group of patients, exceptional changes have occurred to improve overall maternal and infant outcome. Yet there is still room to improve individual analgesia following cesarean section, improve the satisfaction with the child-bearing experience, and augment the resumption of normal activity. Many recent advances in pain management directly benefit the parturient during labor, during delivery, and after her cesarean section. For pain relief during labor, when compared with local anesthetic alone, patients receiving both local anesthetics and low-dose opiates report a more rapid onset of analgesia, more profound analgesia, longer duration of analgesia, and less motor blockade compared with traditional local anesthetic alone. During and following cesarean section, intraspinal opiates, both epidural and intrathecal, provide superior analgesia with tolerable side effects. PCA devices reliably produce sustained pain control with fewer bothersome side effects and are at least equally satisfactory to patients compared with epidural analgesia. In the future, intravenous PCA may deliver improved labor analgesia with insignificant fetal effects accompanied with improved maternal satisfaction. Epidural PCA may receive wider application in the future, both for labor and postoperative analgesia. New drugs are currently under development. Ongoing investigative efforts aim to anatomically target the action of the drug to specific opiate receptors when administered into the intrathecal and epidural space. The future strives to achieve an intraspinal drug with strong analgesic action without production of neonatal effects, maternal respiratory depression, somnolence, nausea, or tolerance.