DOI: 10.1097/ASA.0000000000000009
,
Issn Print: 0363-471X
Publication Date: 2014/01/01
Facebook
Twitter
LinkedIn
Email
 |
Checking for direct PDF access through Ovid | |
Excerpt
As a result of changing obstetric practices, cesarean delivery rates in the United States have steadily increased, and cesarean deliveries now account for over 30% of births annually.1 Pain after cesarean delivery is described as moderate to severe and equivalent to that reported after abdominal hysterectomy.2 Pain associated with cesarean delivery is the most important concern for expectant mothers (Table 1)3 and is often incompletely relieved by current pain management protocols. In an effort to improve pain management, the Joint Commission has proposed postoperative pain as the “fifth vital sign” with a goal of attaining postoperative pain scores consistently below 3 of 10.4 However, studies suggest that this goal is infrequently attained after cesarean delivery.5
Good postcesarean analgesia improves the mother’s ability to function and to interact with her newborn infant,6 and effective pain management is an essential element of good postoperative care. The purpose of this chapter was to summarize various multimodal analgesic options to manage pain effectively after cesarean delivery. The role of neuraxial opioids, nonsteroidal antiinflammatory agents, acetaminophen, gabapentin, wound infiltration, transversus abdominis plane (TAP) blocks, and future analgesic options are reviewed. Analgesic drug exposure in breast-feeding neonates and techniques to minimize the transfer of analgesics into breast milk are also discussed.
