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Post-caesarean analgesia: What is new?
Sukhyanti Kerai1, Kirti Nath Saxena2, Bharti Taneja2
1Department of Anaesthesiology, Rajiv Gandhi Super Speciality Hospital, New Delhi, India.
Indian Journal of Anaesthesia
|April 14, 2017
Summary
Optimizing pain relief after caesarean section (CS) remains a challenge. While opioids are standard, multimodal approaches incorporating techniques like transversus abdominis plane (TAP) blocks and non-opioid drugs show promise for better post-CS pain management.
Area of Science:
- Anesthesiology and Pain Management
- Obstetrics and Gynecology
- Surgical Recovery
Background:
- Effective post-operative analgesia is crucial for parturient recovery following caesarean section (CS).
- Despite advancements, optimal pain management after CS remains an ongoing challenge.
- Opioids are the current standard but are associated with significant side effects.
Purpose of the Study:
- To systematically review recent advancements in post-caesarean analgesia modalities.
- To evaluate the efficacy of various non-opioid techniques and adjuncts to opioid therapy.
Main Methods:
- Systematic review and quality assessment of 51 randomized controlled trials.
- Included interventions: opioids, transversus abdominis plane (TAP) block, wound infiltration/infusion, ketamine, gabapentin, and ilioinguinal-iliohypogastric nerve block (II-IH NB).
- Focused on post-caesarean analgesia efficacy.
Main Results:
- Opioids remain the gold standard but require combination with non-opioids due to side effects.
- Transversus Abdominis Plane (TAP) block is a well-investigated non-opioid technique, effective in specific CS scenarios (without intrathecal morphine, or under general anesthesia).
- COX-I inhibitors and intravenous paracetamol are beneficial adjuncts; ketamine shows benefit only with spinal anesthesia; gabapentin and II-IH NB require further trials.
Conclusions:
- Multimodal analgesia incorporating non-opioid strategies is essential for effective post-CS pain management.
- Transversus Abdominis Plane (TAP) block is a valuable component of multimodal analgesia for caesarean section.
- Further research is needed for gabapentin and ilioinguinal-iliohypogastric nerve block efficacy in post-CS pain.