Prospect Recommendations - ESRA
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C-Section 2014

Prospect Recommendations

Algorithm for the management of postoperative pain elective C-Section

Overall Recommendations: Pain Management for Elective Caesarean Section Surgery 

Pre-operative Oral gabapentin
Pre-/intra-operative anaesthetic technique CSEA or SpA*
Intra-operative, post-delivery IV paracetamol + IV NSAID #
Wound infiltration with LA or TAP blocks or iliohypogastric/ilioinguinal blocks
Surgical technique Transverse incision†
Non-closure of peritoneum
Postoperative Oral paracetamol + oral NSAID + systemic opioid as rescue
Continuous wound infusion with LA

* IT morphine/epidural opioids are recommended, but alternative analgesic techniques such as wound infiltration with LA, TAP block, iliohypogastric and ilioinguinal blocks should be considered to avoid the potential opioid-related side effects of neuraxial opioids

# IV paracetamol and IV NSAID may not be necessary if neuraxial opioids are used

† Amongst transverse incisions, the Joel-Cohen incision and similar modifications are superior to the Pfannenstiel incision for outcomes related to postoperative pain