Management of post-cesarean delivery analgesia: Pharmacologic strategies

Abstract Introduction: Several analgesic modalities - pharmacological and non-pharmacological-may be used during the cesarean section postoperative period. This document focuses on the different pharmacological strategies available. Objectives: To establish the advantages and disadvantages of the va...

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Published inRevista colombiana de anestesiología : Colombian journal of anesthesiology Vol. 45; no. 4; pp. 327 - 334
Main Authors Ramos-Rangel, Germán E., Ferrer-Zaccaro, Leopoldo E., Mojica-Manrique, Viviana L., González-La Rotta, Mariana
Format Journal Article
LanguagePortuguese
Published SCARE-Sociedad Colombiana de Anestesiología y Reanimación 01.12.2017
Subjects
ANESTHESIOLOGY
Analgesia
Cesárea
Pharmacology
Dolor postoperatorio Analgesia
Drug therapy
Farmacología
Pain postoperative
Tratamiento farmacológico
Cesarean section
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Summary:Abstract Introduction: Several analgesic modalities - pharmacological and non-pharmacological-may be used during the cesarean section postoperative period. This document focuses on the different pharmacological strategies available. Objectives: To establish the advantages and disadvantages of the various pharmacological options used to control pain following a C-section, improving safety and patient satisfaction. Methods: A search was done in Medline, Embase, Lilacs, and The Cochrane Library using the terms "Cesarean section", "Cesarean pain", "Maternal risk", and "Analgesia for cesarean", reviewing articles published in both English and Spanish during the last twenty years. Duplicated articles, redundant or irrelevant content, and articles with methodological flaws were excluded. Results: Neuraxial opioids are widely used in postoperative cesarean section analgesia. However, they have to administered at low doses to ensure the best risk-benefit profile. The use of systemic opioids is also appropriate in these patients, reducing the occurrence of some adverse events associated with intrathecal administration. Multimodal analgesia has proven its effectiveness in postoperative pain control after cesarean delivery, significantly reducing the use of opioids and their associated adverse effects. Conclusions: Notwithstanding the adverse effects described in the literature, the cornerstone of analgesia therapy after cesarean section are opioids, both neuraxial or parenteral administration. Multimodal management using NSAIDs or paracetamol, improves the safety profile and the quality of analgesia, reducing the opioid requirements.
ISSN:0120-3347