Jose Carvalho discussed pain following Caesarian Delivery at the Western Anaesthesia Symposium.
12-15% of patients have chronic pain 10 months following Caesarian section. This is not related to previous surgery, vertical incision, obesity or infection. The more pain a patient has postpartum, the more likely they are to have chronic pain and it is associated with postpartum depression.
The standard practice in his institution is multimodal – neuraxial opioid plus ketoralac (NSAID) plus paracetamol. Patients can be given morphine or hydromorphone. No codeine based analgesics are given.
Certain patients are at high risk for postoperative pain. Temporal summation appears to be an effective tool for screening high risk patients.
Continuous wound infiltration with ropivicaine and diclofenac for 48 hours significantly reduces post operative pain, and may be associated with fewer side effects and length of stay versus spinal morphine (Click here for the paper – O’Neill et al).
The TAP block may be an effective method for reducing post operative pain (in the absence of neuraxial opioids), but it adds little when patients are treated with intrathecal morphine. Which is better – TAP or spinal morphine: spinal morphine.
Intravenous ketamine has been extensively studied in preventing postoperative pain. Patients that are temporal summation positive appear to benefit from ketamine.
Gabapentin appears to be quite promising for post C-Section analgesia: 600mg 1 hour before C-Section reduces postoperative pain. Click here for paper