The Current Consideration, Approach, and Management in Postcesarean Delivery Pain Control: A Narrative Review

Table 4

Randomized controlled studies evaluating administration of acetaminophen for postcesarean delivery analgesia.

Author (year)	Sample size	Intrathecal opioid	Analgesic regimen	Comparison groups	Pain score	Opioid consumption	Opioid-related side effects	Conclusion
Siddik (2001) [117]	80 elective cesarean deliveries under spinal anesthesia	Fent 12.5 μg	Acetaminophen 2 g IV q 6 h; Diclofenac 100 mg rectal q 8 h	Four groups; (i) Group 1: acetaminophen group; (ii) Group 2: diclofenac 100 mg supposition q 8 h; (iii) Group 3: propacetamol + diclofenac; (iv) Group 4: placebo group	At 2 h, VAS both at rest and on cough were significantly lower in groups 2 and 3 compared with group 4.	MO consumption at 2,6, and 24 h was significantly lower in groups 2 and 3 than in groups 1 and 4.; 24 h MO consumption; (i) Group 1: 61.1 ± 23 mg; (ii) Group 2: 36 ± 18 mg; (iii) Group 3: 28.3 ± 15.8 mg; (iv) Group 4: 66.7 ± 20 mg	Incidence of nausea, vomiting, excessive sedation, and pruritus was similar for all groups. No patient had respiratory depression.	Adding acetaminophen to diclofenac improves analgesia and has a highly significant morphine sparing effect.
Paech (2013) [118]	111 elective cesarean deliveries under CSE	Fent 15 μg	Acetaminophen IV 2 g and then 1 g oral q 6 h	Four groups; (i) Group 1: acetaminophen 2 g IV then 1 gm oral q 6 h  × 3 doses; (ii) Group 2: Parecoxib 40 mg IV then celecoxib 400 mg at 12 h; (iii) Group 3: Control group	No difference in 24 and 48 h pain at rest or with movement	No difference in total postoperative meperidine consumption	No difference in incidence of N/V or severity of sedation between groups incidence, and severity of pruritus was greater in the treatment groups than in the control group.	Addition of regular acetaminophen, COX-2 inhibitors, or both to meperidine. PCEA did not exhibit a meperidine dose-sparing effect during the first 24 h
Ozmete (2016) [119]	60 elective cesarean deliveries under GA	—	Acetaminophen 1 g IV before induction of anesthesia + IV PCA morphine	Two groups; (i) Group 1: acetaminophen group; (ii) Group 2: placebo group	Median VAS scores were significantly lower in group 1 than in group 2 at all postoperative time points except for the score at 24 h postoperatively	24 h MO consumption; (i) Group 1: 24 (IQR: 14–31) mg; (ii) Group 2: 38 (IQR: 26–46) mg,  ≤ 0.001	No difference in the incidence of sedation or nausea	Preoperative acetaminophen 1 g IV single dose effectively decreased in pain reduction and opioid requirement within 24 h after cesarean delivery
Alteau (2017) [110]	104 cesarean deliveries under regional anesthesia	N/A	Acetaminophen 1 g IV q 8 h. First dose begins 30–60 min before skin incision.	Two groups; (i) Group 1: acetaminophen group; (ii) Group 2: placebo group	No difference in pain score	24 h MO consumption was lower in the acetaminophen group (47 ± 39.1 mg) than in the placebo group (65 ± 46.24 mg),  < 0.034	No difference in incidence of N/V, respiratory depression, or constipation	IV acetaminophen reduces oral narcotic consumption after cesarean delivery
Tower (2018) [120]	105 elective cesarean deliveries under spinal anesthesia	Fent 20 μg + MO 0.2 mg	Acetaminophen 1 g IV prior to spinal block	Two groups; (i) Group 1: acetaminophen group; (ii) Group 2: placebo group	No difference in pain score	No difference in opioid requirement; (i) Group 1: 94.2 ± 40.4 mg; (ii) Group 2: 90.7 ± 42.1 mg, P 0.67	N/A	Preoperative IV acetaminophen single dose did not reduce pain score or postoperative opioid consumption

All analgesics are administered postoperatively unless indicated. All visual analogue scale or postoperative morphine consumption are reported as mean ± standard deviation (SD) unless otherwise specified. COX, cyclooxygenase enzyme; CSE, combined spinal epidural anesthesia; Fent, fentanyl; GA, general anesthesia; g, gram; h, hour; IQR, interquartile range; IV, intravenous; mg, milligram; MO, morphine; N/A, not applicable; PCA, patient-controlled analgesia; VAS, visual analogue scale.