Chapter 21 - Analgesia post cesarean section

Summary

This chapter serves as a guide for the current clinical management options for analgesia post cesarean section, and discusses the controversies around this cesarean section. The addition of an opioid to intrathecally or epidurally administered local anesthetic helps maintaining prolonged analgesia after cesarean section. Adverse effects of neuraxial opioids are dose dependent and include sedation, pruritus, nausea, vomiting, constipation, urinary retention, and respiratory depression. Opioids administered intrathecally act on the µ (mu) receptors in the substantia gelatinosa of the dorsal horn by suppressing excitatory neuropeptide release from C fibers. The degree of uptake from the cerebrospinal fluid is determined by the lipid solubility of the drug. Systemic administration of opioids is commonly used for post cesarean section pain management after general anesthesia. The Pfannenstiel incision is a favorable approach for cesarean deliveries and other gynecologic surgeries due to its low rate of incisional hernias and discrete scar line.