PROSPECT provides clinicians with supporting arguments for and against the use of various interventions in postoperative pain based on published evidence and expert opinion. Clinicians must make judgements based upon the clinical circumstances and local regulations. At all times, local prescribing information for the drugs referred to must be consulted.
Grades of recommendation are assigned according to the overall level of evidence on which the recommendations are based, which is determined by the quality and source of evidence: Relationship between quality and source of evidence, levels of evidence and grades of recommendation.
Caesarean section is associated with moderate-to-severe postoperative pain in a signiﬁcant proportion of women, which may delay recovery and return to activities of daily living; impair mother-child bonding; impact maternal psychological well-being; and complicate breastfeeding (Gamez 2018). Furthermore, inadequate postoperative pain relief may lead to hyperalgesia and persistent postoperative pain (Kainu 2010).
Pain after caesarean section is often under-treated due to unfounded fears that analgesic drugs or interventions might induce maternal and neonatal side-effects and because the severity of post-caesarean section pain is often underestimated (Huang 2019).
The procedure-speciﬁc postoperative pain management (PROSPECT) recommendations for pain management after caesarean section were published in 2014 (PROSPECT: C-Section 2014); however, an update was necessary given developments in clinical practice.
The aim of this systematic review was to provide updated recommendations based on recent literature assessing the impact of analgesic and surgical approaches on pain after elective caesarean section performed under neuraxial anaesthesia. These recommendations should not be applied to other patient populations such as emergency or unplanned caesarean section or surgery performed under general anaesthesia.
COX, cyclooxygenase; NSAIDs, non-steroidal anti-inflammatory drugs
COX, cyclooxygenase; NSAIDs, non-steroidal anti-inflammatory drugs; TAP, transversus abdominis plane block
COX, cyclooxygenase; NSAIDs, non-steroidal anti-inflammatory drugs; TENS, transcutaneous electrical nerve stimulation
Analgesic interventions that are not recommended for pain management in patients undergoing elective caesarean section.
TAP, transversus abdominis plane block