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REVIEW ARTICLES

Post-Cesarean Delivery Analgesia

Jeff Gadsden, MD^*, Stuart Hart, MD, and Alan C. Santos, MD, MPH

*Department of Anesthesiology, St. Luke's-Roosevelt Hospital Center of Columbia University, New York, New York; Department of Anesthesiology, Ochsner Clinic Foundation, New Orleans, Louisiana

Address correspondence and reprint requests to Alan C. Santos, MD, MPH, Department of Anesthesiology, Ochsner Clinic Foundation, 1514 Jefferson Highway, New Orleans, LA 70121. Address electronic mail to obanesdoc{at}aol.com.

Post-cesarean delivery pain relief is important. Good pain relief will improve mobility and can reduce the risk of thromboembolic disease, which is increased during pregnancy. Pain may also impair the mother's ability to optimally care for her infant in the immediate postpartum period and may adversely affect early interactions between mother and infant. Pain and anxiety may also reduce the ability of a mother to breast-feed effectively. It is necessary that pain relief be safe and effective, that it not interfere with the mother's ability to move around and care for her infant, and that it result in no adverse neonatal effects in breast-feeding women. The most commonly used modalities are systemic administration of opioids, either by intramuscular injection or IV by patient-controlled analgesia, and neuraxial injection of opioid as part of a regional anesthetic for cesarean delivery. These techniques have specific advantages and disadvantages which will be discussed in this review. In addition, there are new drug applications of potential benefit for the treatment of post-cesarean delivery pain.

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