Comparison of analgesic modalities after cesarean section: a network meta-analysis and systematic review

Cesarean section is one of the most common surgical procedures. Currently, there are many analgesic methods available after cesarean section, but the optimal analgesic method after cesarean section is not clear.

A network meta-analysis of randomized controlled trials was used to search Embase, PubMed, Web of Science, and Cochrane databases. Outcomes included time to first postoperative request for analgesia, postoperative medication-supplemented analgesia, pain scores at four postoperative time points, postoperative complications (nausea and vomiting, itching, and level of sedation), and patient satisfaction.

A total of 110 randomized controlled trials involving 8871 pregnant women were finally included. A total of 17 postoperative analgesic techniques for cesarean delivery were included. Compared with the control group, all modalities except wound infiltration prolonged the time to the first request for analgesia. Transversal abdominal block-type and lumbar quadratus block-type analgesia were effective in decreasing the need for opioids in postoperative patients. Wound infiltration and transversalis fascia plane decreased the need for nonopioid medications in postoperative patients. The traditional analgesic modalities of intrathecal morphine (IM) and epidural morphine have the best analgesic effect, and the analgesic effect of the type of transversal abdominal block and the type of lumbar square muscle block in local anesthesia is better than that of other local anesthesia modalities. The lateral transversus abdominis block and posterior and anterior lumbar square muscle block can effectively reduce postoperative complications with the best effect. In terms of patient satisfaction, IM with conventional Petit transverse abdominal block was the best.

Regional nerve block is a safe and effective postoperative analgesic modality; QLB III, which is used to use opioids as postoperative supplemental analgesia, is the safest and most effective analgesic modality, and those who are used to use non-opioids as postoperative supplemental analgesia can choose transversalis fascia plane as a postoperative analgesic modality.