Perioperative Analgesia in Caesarean Section: What's New?

*José Ramón Saucillo-Osuna, Eduardo Antonio Wilson-Manríquez, Mercedes Nicte López-Hernández and Ana Lilia Garduño-López*

#### **Abstract**

Caesarean section is associated with moderate to severe postoperative pain during the first 24 hours after surgery. Inadequate pain management can influence recovery, maternal psychological well-being and breastfeeding. In the search of alternatives to minimize the use of systemic opioids, new recommendations have been made to implement protocols to improve recovery after caesarean section, with multimodal analgesia, new suggestions for neuraxial techniques, regional analgesia with ultrasound-guided fascial plane blocks and non-pharmacological approaches. Some of the interventions, such as epidural or spinal blocks, although effective, carry a significant risk of complications (for example post-puncture headache). In their place, newer alternatives such as interventions guided by ultrasound are safe and effective for relieving pain in this common clinical context. The goal of this chapter is to provide clinicians with up-to-date evidence for optimal pain management after elective caesarean section.

**Keywords:** caesarean section analgesia, pain after caesarean, multimodal analgesia, systemic opioids, regional blocks

#### **1. Introduction**

Caesarean section is the most performed surgical procedure in the world. This procedure is associated with moderate to severe postoperative pain during the first 24 hours after surgery. Inadequate pain management can influence recovery, maternal psychological well-being and breastfeeding. A core principle of successful postoperative analgesia is implementation of multimodal analgesia, and the caesarean section is no exception to the rule. The most effective and evidence-based intervention for effective postoperative analgesia for caesarean section is the use of neuraxial techniques such as epidural block, subarachnoid block or combined techniques, where morphine has played a fundamental role in analgesia in this surgery combined with non-steroidal anti-inflammatory drugs (NSAIDs) and acetaminophen [1]. However, there are multiple factors that may cause a patient to experience discomfort or pain during caesarean section, some of which are preventable and must certainly be


**Table 1.**

*Overall recommendations for pain management in patients undergoing planned caesarean section.*

managed. Therefore, knowing the updates on postoperative pain management in caesarean section gives us tools that allow us to manage pain in specific scenarios and individually. The most recent guidelines for the management of specific postoperative pain in caesarean section have been published by the Prospect Group [2], and their recommendations have been summarized in **Table 1**.
