Review Article

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

Table 5

Postoperative analgesic recommendation for cesarean delivery.

SOAP consensus statement [6]ERAS society [7]PROSPECT guideline [37]

MorphineNeuraxial long-acting opioid example:
Intrathecal morphine 50–150 mcg or epidural morphine 1–3 mg
Long-acting intrathecal opioids such as morphine provides analgesia for several hours after cesarean delivery, although the expense of a number of side effects include nausea, vomiting, and pruritus.Intrathecal morphine 50–100 mcg or diamorphine 300 mcg. Epidural morphine 2-3 mg or diamorphine 2-3 mg may be administered as an alternative.

Acetaminophen and NSAIDsNSAIDs analgesia started in OR unless contraindicated:
(i) Ketorolac 15–30 mg IV after peritoneum closed
(ii) Acetaminophen IV after delivery or orally, per oral before or after delivery
Regular NSAID and acetaminophen are recommended for enhanced recovery for cesarean delivery.Prescribe acetaminophen and a NSAID administered after delivery and continued regularly postoperatively.

DexamethasoneA single dose of IV dexamethasone after delivery in the absence of contraindication

Local anesthetic techniquesConsider local anesthetic wound infiltration or regional blocks such as bilateral TAP or QL blocks if neuraxial morphine is not administered.In the absence of long-acting intrathecal opioids, the TAP field block provides excellent postoperative pain control. A Cochrane review of local analgesia infiltration and abdominal nerve blocks found that they improved postoperative analgesia for cesarean delivery.Consider a single injection of local anesthetic infiltration, continuous wound local anesthetic infusion, and/or fascial plane blocks, if intrathecal morphine is not administered.

ERAS, enhanced recovery after surgery; IV, intravenous; NSAID, nonsteroidal anti-inflammatory drug; PROSPECT, procedure-specific postoperative pain management; OR, operating room; QLB, quadratus lumborum block; SOAP, Society for Obstetric Anesthesia and Perinatology; TAP, transversus abdominis plane block.