Optimal Treatment for Incisional Pain After C-Section
First-Line Pharmacological Management
- The American Society of Anesthesiologists recommends a multimodal approach including scheduled paracetamol and NSAIDs as basic analgesics, with intrathecal morphine 50-100 μg or diamorphine 300 μg administered pre-operatively, and intravenous dexamethasone after delivery 1, 2
- Add intrathecal morphine 50-100 μg or diamorphine 300 μg to spinal anesthesia for post-cesarean pain management 1, 4
- Implement one of these regional techniques: single-injection local anesthetic wound infiltration, continuous wound local anesthetic infusion, or fascial plane blocks (transversus abdominis plane or quadratus lumborum blocks) if neuraxial opioids were not administered 1, 3, 4
- Administer a single dose of intravenous dexamethasone after delivery (unless contraindicated) 1, 4
Surgical Techniques That Reduce Post-Cesarean Pain
- The American College of Obstetricians and Gynecologists recommends using Joel-Cohen incision technique during the cesarean section 1, 3
- Implement non-closure of the peritoneum 1, 3
- Apply abdominal binders postoperatively 1, 3
Non-Pharmacological Adjuncts
- Consider transcutaneous electrical nerve stimulation (TENS) as an analgesic adjunct 1
Important Considerations and Pitfalls
- The benefits of local and regional analgesic techniques are minimal when intrathecal morphine is used, so these should be reserved for cases where neuraxial opioids are contraindicated 1, 3, 6
- Develop individualized post-discharge opioid prescribing practices to reduce unnecessary opioid consumption after discharge 1