Post-Caesarean Pain

Cesarean delivery is one of the most common surgical procedures performed. The unique nature of the obstetric patient population underscores the importance of adequate postoperative analgesia following cesarean delivery. Those women need to be able to care for their newborns, breastfeed and mobilize early since they are at high risk for thromboembolic complications. Furthermore, severe acute pain increases the risk for persistent pain and postpartum depression. Enhanced recovery after surgery protocols are becoming increasingly popular in the obstetric patient population, and pain management is an integral part of those protocols. Various modalities are used for the management of post cesarean pain including opioids (systemic and neuraxial), neuraxial techniques, systemic adjuncts, and local anesthetic techniques. One of the challenges facing clinicians is the wide inter-individual variability in pain experience after cesarean delivery as well as the variability in patients’ preference for the tradeoff between analgesia and side effects of analgesic interventions. Therefore, personalized targeted postoperative analgesia regimens could optimize postoperative pain management and improve patients’ outcomes and satisfaction. Another problem facing clinicians is the increasing number of opioid dependent parturients, who present significant challenges with regards to postoperative pain management.

This special issue on post cesarean delivery pain will address various aspects of postoperative pain management after cesarean delivery including 1. Targeted postoperative analgesia, 2. Persistent pain after cesarean delivery, 3. Opioids, neuraxial techniques and neuraxial adjuncts, 4. Local anesthetic techniques, 5. Systemic adjuncts, 6. Management of side effects of neuraxial opioids, 7. Postoperative analgesia as part of an ERAS protocol, 8. Postoperative analgesia in the opioid dependent parturient, and 9. Postoperative analgesia in a resource poor setting.