Managing the pain

of caesarian sections

The importance of minimizing opioids postpartum

Following a caesarian section, the safety and comfort of mother and baby are paramount. To this end, managing the mother’s postoperative pain is critical. Untreated pain is associated with a greater risk of opioid use, postpartum depression, and the development of persistent pain. In fact, 1 in 300 opioid-naïve patients exposed to opioids after a C-section will become persistent opioid users.1

In their guideline for postpartum pain management, the American College of Obstetricians and Gynecologists (ACOG) recommends a multimodal stepwise approach to minimize the use of opioids and individualize treatment for each patient.1 But in the effort to reduce the amount of opioids consumed by recovering mothers, one important tool may be underutilized: local anesthetics.

Though regional blocks are common, it has been thought that for patients who receive spinal anesthesia, the benefit of local anesthesia delivered via wound infiltration was minimal because of its short duration; the analgesic effects were likely to wear off before those off the spinal anesthesia.2

What if local anesthetics could work longer?

A longer-acting local anesthetic could impact the way we treat postoperative obstetric pain.3-6

Many experts agree: it’s time to update the existing WHO analgesic ladder, which suggests heavy use of opioids.

New potential analgesic ladder suggests development of longer-acting local anesthetics to minimize the need of opioids after surgery.

Slide to see the impact a longer-acting local anesthetic could have

Learn more about local anesthesia as a first line of defense against postoperative pain »

Top Procedures

  • Caesarian section
  • Sterilization
  • Hysterectomy

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References: 1. ACOG Committee Opinion No. 742. Obstetrics & Gynecology. 2018;132(1). doi:10.1097/aog.0000000000002683. 2. Sutton CD, Carvalho B. Optimal Pain Management After Cesarean Delivery. Anesthesiology Clinics. 2017;35(1):107-124. doi:10.1016/j.anclin.2016.09.010. 3. Vargas-Schaffer G. Is the WHO analgesic ladder still valid? Twenty-four years of experience. Can Fam Physician. 2010;56(6):514-517. 4. Vargas-Schaffer G. Patient therapeutic education: placing the patient at the centre of the WHO analgesic ladder. Can Fam Physician. 2014;60(3):235-241. 5. Pergolizzi JV, Paladini A, Varrassi G, Raffa RB. Change pain: ever evolving—an update for 2016. Pain Ther. 2016;5:127-133. doi:10.1007/s40122-016-0058-x. 6. Crews JC. Multimodal pain management strategies for office-based and ambulatory procedures. JAMA. 2002;288(5):629-632. doi:10.1001/jama.288.5.629.