Management of Groin Pain After Cesarean Section

Initial Assessment and Immediate Management

The American College of Anaesthesiologists recommends prescribing scheduled paracetamol and NSAIDs as foundational analgesics for all post-cesarean pain, including groin pain, with a strength of evidence level of high 2, 3, 4, 1
The Anaesthesia society suggests adding a single dose of intravenous dexamethasone if not already administered during the cesarean delivery, unless contraindicated, with a moderate level of evidence 3, 4, 1
Minimizing systemic opioid use through individualized prescribing practices is crucial, particularly for breastfeeding mothers, as recommended by the Anaesthesia society, with a high level of evidence 2, 4

The Anaesthesia society considers ilioinguinal-iliohypogastric (II/IH) nerve blocks as both diagnostic and therapeutic interventions for groin pain, especially when the pain is burning, lancinating, or exacerbated by standing or movement, with a moderate level of evidence 5
Implementing local anesthetic infiltration or fascial plane blocks, such as transversus abdominis plane or quadratus lumborum blocks, is recommended if intrathecal morphine was not used during the cesarean section, with a high level of evidence 3, 6, 4, 1

The Anaesthesia society recommends implementing multimodal analgesia with scheduled paracetamol and NSAIDs in the early phase, with a high level of evidence 2, 3, 4, 1
Applying transcutaneous electrical nerve stimulation (TENS) as an adjunctive measure is suggested, with a moderate level of evidence 3, 6, 1
Using abdominal binders for additional pain control is recommended, with a moderate level of evidence 3, 6, 4, 1

The Anaesthesia society advises against dismissing persistent groin pain as "normal" post-cesarean discomfort, as it may represent specific nerve injury requiring targeted intervention, with a high level of evidence 1
The benefits of local and regional analgesic techniques are minimal when intrathecal morphine was used, so they should be reserved for cases where neuraxial opioids were contraindicated or not administered, with a moderate level of evidence 5, 1, 7