International Journal of Obstetric Anesthesia
Volume 15, Issue 3 , Pages 185-188 , July 2006

Post cesarean delivery pain management: multimodal approach

  • Peter H. Pan, MSEE, MD (Associate Professor, Director of Clinical Research, Section of Obstetric Anesthesia)

,Accepted 4 April 2006.

References 

  1. Turk DC, Okifuji A. Assessment of patients’ reporting of pain: an integrated perspective. Lancet. 1999;352:1784–1788
  2. Bisgaard T, Klarskov B, Rosenberg J, Kehlet H. Characteristics and prediction of early pain after laparoscopic cholecystectomy. Pain. 2001;90:261–269
  3. Pan PH, Coghill R, Houle T, et al. Multifactorial preoperative predictors for post cesarean section pain and analgesic requirement. Anesthesiology. 2006;104:417–425
  4. Dolin ST, Cashman JN, Bland JM. Effectiveness of acute postoperative pain management: I. Evidence from published data. Br J Anaesth. 2002;89:409–423
  5. Apfelbaum JL, Chen C, Mehta SS, Gan TJ. Postoperative pain experience: results from a national survey suggest postoperative pain continues to be undermanaged. Anesth Analg. 2003;97:534–540
  6. Perkins FM, Kehlet H. Chronic pain as an outcome of surgery: A review of predictive factors. Anesthesiology. 2000;95:1123–1133
  7. Pan PH, Bogard TD, Owen MD. Incidence and characteristics of failures in obstetric neuraxial analgesia and anesthesia: a retrospective analysis of 19,259 deliveries. Int J Obstet Anesth. 2004;13:227–233
  8. Jenkins JG, Khan MM. Anaesthesia for Caesarean section: a survey in a UK region from 1992 to 2002. Anaesthesia. 2003;58:1114–1118
  9. Hawkins JL, Gibbs C, Orleans M, Martin-Salvaj G, Beaty B. Obstetric anesthesia workforce survey, 1981 versus 1992. Anesthesiology. 1997;87:135–143
  10. Block BM, Liu SS, Rowlingson AJ, Cowan AR, Cowan JA, Wu CL. Efficacy of postoperative epidural analgesia: a meta-analysis. JAMA. 2003;290:2455–2463
  11. Gwirtz KH, Young JV, Byers RS, et al. The safety and efficacy of intrathecal opioid analgesia for acute pain: seven years’ experience with 5,969 surgical patients at Indiana University Hospital. Anesth Analg. 1999;88:599–604
  12. Dahl JB, Jeppesen IS, Jorgensen H, Wetterslev J, Moiniche S. Intraoperative and postoperative analgesic efficacy and adverse effects of intrathecal opioids in patients undergoing Cesarean section with spinal anesthesia. A qualitative and quantitative systematic review of randomized controlled trials. Anesthesiology. 1999;91:1919–1927
  13. Palmer CM, Nogami WM, Van Maren G, Alves DM. Postcesarean epidural morphine: a dose-response study. Anesth Analg. 2000;90:887–891
  14. Rosen MA, Hughes SC, Shnider SM, et al. Epidural morphine for the relief of postoperative pain after cesarean delivery. Anesth Analg. 1983;62:666–672
  15. Cohen S, Pantuck CB, Amar D, Burley E, Pantuck EJ. The primary action of epidural fentanyl after Cesarean delivery is via a spinal mechanism. Anesth Analg. 2002;94:674–679
  16. Ready LB. Acute pain: lessons learned from 25,000 patients. Reg Anesth Pain Med. 1999;24:499–505
  17. Rawal N, Allvin R. Euro Pain Study Group on Acute Pain. Epidural and intrathecal opioids for postoperative pain management in Europe – a 17 nation questionnaire study of selected hospitals. Acta Anaesthesiol Scand. 1996;40:1119–1126
  18. Moore A, Bullingham R, McQuay H, et al. Spinal fluid kinetics of morphine and heroin. Clin Pharmacol Ther. 1984;35:40–45
  19. Wee MYK, Brown H, Reynolds F. The National Institute for Clinical Excellence (NICE) guidelines for caesarean sections: implications for the anaesthetist. Int J Obstet Anesth. 2005;14:147–158
  20. Quigley C. Hydromorphone for actue and chronic pain. Cochrane Database Syst Rev. 2002;(1):CD003447
  21. Larijani GE, Sharaf I, Warshal DP, Marr A, Gratz I, Goldberg ME. Pain evaluation in patients receiving intravenous patient-controlled analgesia after surgery. Pharmacotherapy. 2005;25:1168–1173
  22. Eisenach JC, Grice SC, Dewan DM. Patient-controlled analgesia following cesarean section: a comparison with epidural and intramuscular narcotics. Anesthesiology. 1988;68:444–448
  23. Vicente KJ, Kada-Bekhaled K, Hillel G, Cassano A, Orser BA. Programming errors contributing to death from patient-controlled analgesia: case report and estimate of probability. Can J Anesth. 2003;50:328–332
  24. Abouleish E, Rawal N, Rashad MN. The addition of 0.2 mg subarachnoid morphine to hyperbaric bupivacaine for cesarean delivery: A prospective study of 856 cases. Reg Anesth. 1991;16:137–140
  25. Wilder-Smith CH, Hill L, Dyer RA, Torr G, Coetzee E. Postoperative sensitization and pain after Cesarean delivery and the effects of single im doses of tramadol and diclofenac alone and in combination. Anesth Analg. 2003;97:526–533
  26. Lowder JL, Shackelford DP, Holbert D, Beste TM. A randomized, controlled trial to compare ketorolac tromethamine versus placebo after cesarean section to reduce pain and narcotic usage. Am J Obstet Gynecol. 2003;189:1559–1562
  27. American Academy of Pediatrics Committee on Drugs. The transfer of drugs and other chemicals into human milk. Pediatrics 2001;108–776–785.
  28. Hyllested M, Jones S, Pedersen JL, Kehlet H. Comparative effect of paracetamol, NSAIDs or their combination in postoperative pain management: a qualitative review. Br J Anaesth. 2002;88:199–214
  29. Liu SS, Hodgson PS, Moore JM, Trautman WJ, Burkhead DL. Dose-response effects of spinal neostigmine added to bupivacaine spinal anesthesia in volunteers. Anesthesiology. 1999;90:710–717
  30. Eisenach JC, Kock MC, Klimscha W. Alpha-2 adrenergic agonists for regional anesthesia: A clinical review of clonidine (1984–1995). Anesthesiology. 1996;85:655–674
  31. Dahl J, Moiniche S, Kehlet H. Wound infiltration with local anaesthetics for postoperative pain. Acta Anaesthesiol Scand. 1994;38:7–14
  32. Ranta PO, Ala-Kokko TI, Kukkonen JE, et al. Incisional and epidural analgesia after caesarean delivery. A prospective, placebo-controlled, randomized clinical study. Int J Obstet Anesth. 2006;15:189–194
  33. Lavand’homme PM, Roelants F, Mercier V, Waterloos H. Continuous wound instillation after cesarean section: local analgesic effect of diclofenac. Anesthesiology. 2004;100(Supp l):A22

PII: S0959-289X(06)00056-2

doi: 10.1016/j.ijoa.2006.04.004

International Journal of Obstetric Anesthesia
Volume 15, Issue 3 , Pages 185-188 , July 2006

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