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Postoperative Analgesia

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Anesthesia for Cesarean Section

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Abstract

Cesarean section (CS) is a unique surgery, accompanied by significant hormonal and emotional pregnancy modifications, the arrival of the newborn with consequent care responsibilities, the expectation to recover rapidly, and sleep deprivation resulting from maternal neonatal interactions. Indeed the period after cesarean surgery is not only a postoperative but also a postpartum period (puerperium).

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References

  1. Bonnet MP, Mignon A, Mazoit JX, Ozier Y, Marret E. Analgesic effect and adverse effects of epidural morphine compared to parenteral opioids after elective caesarean section: a systematic review. Eur J Pain. 2010;14:894–9.

    Article  PubMed  Google Scholar 

  2. Wu CL, Naqibuddin M, Rowlingson AJ, Lietman SA, Jermyn RM, Fleisher LA. The effect of pain on health-related quality of life in the immediate postoperative period. Anesth Analg. 2003;97:1078–85.

    Article  PubMed  Google Scholar 

  3. Ismail S, Shahzad K, Shafiq F. Observational study to assess the effectiveness of postoperative pain of patients undergoing elective cesarean section. J Anaesthesiol Clin Pharmacol. 2012;28:36–40.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Leung A. Postoperative pain management in obstetric—new challenges and solutions. J Clin Anesth. 2004;16:57–65.

    Article  PubMed  Google Scholar 

  5. Cooper PJ, Murray L. Post natal depression. BMJ. 1988;316:1884–6.

    Article  Google Scholar 

  6. Annika Karlström A, Engström-Olofsson R, Norbergh KG, Sjöling M, Hildingsson I. Postoperative pain after cesarean birth affects breastfeeding and infant care. J Obstet Gynecol Neonatal Nurs. 2007;36:430–40.

    Article  PubMed  Google Scholar 

  7. Eisenach JC, Pan PH, Smiley R, et al. Severity of acute pain after childbirth, but not type of delivery, predicts pain and post partum depression. Pain. 2008;15:87–94.

    Article  Google Scholar 

  8. Kehlet H, Jensen TS, Woolf CJ. Persistent postsurgical pain: risk factors and prevention. Lancet. 2006;367:1618–25.

    Article  PubMed  Google Scholar 

  9. Perkins FM, Kehlet H. Chronic pain as an outcome of surgery—a review of predictive factors. Anesthesiology. 2000;93:1123–33.

    Article  CAS  PubMed  Google Scholar 

  10. Mathai M, Hofmeyr GJ, Mathai NE. Abdominal surgical incisions for caesarean section. Cochrane Database Syst Rev. 2013;5:CD004453.

    Google Scholar 

  11. Rousseau JA, Girard K, Turcot-Lemay L, Thomas N. A randomized study comparing skin closure in cesarean sections: staples vs. subcuticular sutures. Am J Obstet Gynecol. 2009;200:265.e1–4.

    Article  Google Scholar 

  12. Nafisi S. Influence of uterine exteriorization versus in situ repair on post-cesarean maternal pain: a randomized trial. Int J Obstet Anesth. 2007;16:135–8.

    Article  CAS  PubMed  Google Scholar 

  13. Chooi CLS, White AM, Tan SGM, Dowling K, Cyna AM. Pain vs. comfort scores after caesarean section: a randomized trial. Br J Anaesth. 2013;110:780–7.

    Article  CAS  PubMed  Google Scholar 

  14. Lim Y, Jha S, Sia AT, et al. Morphine for post cesarean section analgesia: intrathecal, epidural or intravenous? Singapore Med J. 2005;46:392–6.

    CAS  PubMed  Google Scholar 

  15. Cade L, Ashley J. Towards optimal analgesia after caesarean section: comparison of epidural and intravenous patient-controlled opioid analgesia. Anaesth Intensive Care. 1993;21:696–9.

    CAS  PubMed  Google Scholar 

  16. Vercauteren M, Vereecken K, La Malfa M, et al. Cost-effectiveness of analgesia after caesarean section. A comparison of intrathecal morphine and epidural PCA. Acta Anaesthesiol Scand. 2002;46:85–9.

    Article  CAS  PubMed  Google Scholar 

  17. Palmer CM, Nogami WM, Van Maren G, et al. Post cesarean epidural morphine: a dose-response study. Anesth Analg. 1990;90:887–91.

    Article  Google Scholar 

  18. Ready LB. Acute postoperative pain. In: Miller RD, editor. Anaesthesia, vol. 2. New York: Churchill Livingstone; 1994. p. 2327–44.

    Google Scholar 

  19. Fuller JG, McMorland GH, et al. Epidural morphine for analgesia after caesarean section: a report of 4880 patients. Can J Anaesth. 1990;37:636–40.

    Article  CAS  PubMed  Google Scholar 

  20. Dahl JB, Jeppesen IS, Jorgesen H, et al. 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;91:1919–27.

    Article  CAS  PubMed  Google Scholar 

  21. Cousins MJ, Mather LE. Intrathecal and epidural administration of opioids. Anesthesiology. 1984;61:276–310.

    Article  CAS  PubMed  Google Scholar 

  22. Bromage PR, Camporesi EM, Durant PA, Nielsen CH. Rostral spread of epidural morphine. Anesthesiology. 1982;56:431–6.

    Article  CAS  PubMed  Google Scholar 

  23. Leysen JE, Commereu W, Niemegeers CJE. Sufentanil, a superior ligand for μ-opiate receptors: binding properties and regional distribution in rat brain and spinal cord. Eur J Pharmacol. 1983;87:209–25.

    Article  CAS  PubMed  Google Scholar 

  24. Camorcia M, Capogna G, Columb MO. Minimum analgesic doses of fentanyl and sufentanil for epidural analgesia in the first stage of labor. Anesth Analg. 2003;96:1178–82.

    PubMed  Google Scholar 

  25. Grass JA, Sakima NT, Schmidt R, Michtisch R, Zuckerman RL, Harris AP. A randomized, double-blind, dose-response comparison of epidural fentanyl versus sufentanil analgesia after cesarean section. Anesth Analg. 1997;85:365–71.

    CAS  PubMed  Google Scholar 

  26. Palmer CM, Voulgaropoulos D, Alves D. Subarachnoid fentanyl augments lidocaine spinal anesthesia for cesarean delivery. Reg Anesth. 1995;20:389–94.

    CAS  PubMed  Google Scholar 

  27. Bernards CM. Recent insights into the pharmacokinetics of spinal opioids and the relevance to opioid selection. Curr Opin Anaesthesiol. 2004;17:441–7.

    Article  PubMed  Google Scholar 

  28. Palmer CM, Emerson S, Volgoropolous D, et al. Dose response relationship of intrathecal morphine for post cesarean analgesia. Anesthesiology. 1999;90:437–44.

    Article  CAS  PubMed  Google Scholar 

  29. Sarvela J, Halonen P, Soikkeli A, et al. A double blinded randomized comparison of intrathecal and epidural morphine for elective cesarean delivery. Anesth Analg. 2002;95:436–40.

    CAS  PubMed  Google Scholar 

  30. Sibilla C, Albertazzi P, Zatelli R, et al. Perioperative analgesia for caesarean section: comparison of intrathecal morphine and fentanyl alone or in combination. Int J Obstet Anaesth. 1997;6:43–8.

    Article  CAS  Google Scholar 

  31. SM S-S, Aouad MT, Jalbout MI, et al. Intrathecal versus intravenous fentanyl for supplementation of subarachnoid block during cesarean delivery. Anesth Analg. 2002;95:209–13.

    Article  Google Scholar 

  32. Dahlgren G, Hulstrand C, Jakobsson J, et al. Intrathecal sufentanil, fentanyl, or placebo added to bupivacaine for cesarean section. Anesth Analg. 1997;85:1288–93.

    Article  CAS  PubMed  Google Scholar 

  33. Milner AR, Bogod DG, Harwood RJ. Intrathecal administration of morphine for elective caesarean section. Anaesthesia. 1996;51:871–3.

    Article  CAS  PubMed  Google Scholar 

  34. Wong JY, Carvalho B, Riley ET. Intrathecal morphine 100 and 200 μg for post-cesarean delivery analgesia: a trade-off between analgesic efficacy and side effects. Int J Obstet Anaesth. 2013;22:36–41.

    Article  CAS  Google Scholar 

  35. Berger JS, Gonzalez A, Hopkins A, et al. Dose-response of intrathecal morphine when administered with intravenous ketorolac for post-cesarean analgesia: a two-center, prospective, randomized, blinded trial. Int J Obstet Anesth. 2016;28:3–11.

    Article  CAS  PubMed  Google Scholar 

  36. Moore A, Bullingham R, McQuay H, et al. Spinal fluid kinetics of morphine and heroin. Clin Pharmacol Ther. 1984;35:40–5.

    Article  CAS  PubMed  Google Scholar 

  37. Skilton RW, Kinsella SM, Smith A, et al. Dose response study of subarachnoid diamorphine for analgesia after elective caesarean section. Int J Obstet Anaesth. 1999;8:231–5.

    Article  CAS  Google Scholar 

  38. Kelly MC, Carabine UA, Mirakhur RK. Intrathecal diamorphine for analgesia after caesarean section. A dose finding study and assessment of side-effects. Anaesthesia. 1998;53:231–7.

    Article  CAS  PubMed  Google Scholar 

  39. Saravan S, Robinson APC, Qayoum D, et al. Minimum dose if intrathecal diamorphine required to prevent intraoperative supplementation of spinal anaesthesia for caesarean section. Br J Anaesth. 2003;91:368–72.

    Article  Google Scholar 

  40. Lyons G. Dose of intrathecal diamorphine for caesarean section and position for spinal insertion. Br J Anaesth. 2004;92:448–9.

    Article  Google Scholar 

  41. Roulson CJ, Bennett J, Shaw M, et al. Effect of extradural diamorphine on analgesia after cesarean section under subarachnoid block. Br J Anaesth. 1993;71:810–3.

    Article  CAS  PubMed  Google Scholar 

  42. Hallworth SP, Fernando R, Bell R, et al. Comparison of intrathecal and epidural diamorphine for elective caesarean section using a combined spinal epidural technique. Br J Anaesth. 1999;82:228–32.

    Article  CAS  PubMed  Google Scholar 

  43. Bloor GK, Thompson M, Chung N. A randomized, double blind comparison of subarachnoid and epidural diamorphine for elective caesarean section using a combined spinal epidural technique. Int J Obstet Anesth. 2000;9:233–7.

    Article  CAS  PubMed  Google Scholar 

  44. Carvalho B, Roland LM, Chu LF, et al. Single-dose, extended-release epidural morphine (DepoDur) compared to conventional epidural morphine for post-cesarean pain. Anesth Analg. 2007;105:176–83.

    Article  CAS  PubMed  Google Scholar 

  45. Eisenach JC, Grice SC, Dewan DM. Patient controlled analgesia following cesarean section: a comparison with epidural and intramuscular narcotics. Anesthesiology. 1988;68:444–8.

    Article  CAS  PubMed  Google Scholar 

  46. Parker RK, Holtman B, White PF. Patient controlled analgesia: does a concurrent opioid infusion improve pain management after surgery? JAMA. 1991;266:1947–52.

    Article  CAS  PubMed  Google Scholar 

  47. Jenkins JG, Khan MM. Anaesthesia for caesarean section: a survey in the UK region from 1992 to 2001. Anaesthsia. 2003;58:1114–8.

    Article  CAS  Google Scholar 

  48. 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;97:526–33.

    Article  CAS  PubMed  Google Scholar 

  49. 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;189:1559–62.

    Article  CAS  PubMed  Google Scholar 

  50. Cardoso M, Carvalho J, Amaro A, et al. Small doses of intrathecal morphine combined with systemic diclofenac for postoperative pain control after cesarean delivery. Anesth Analg. 1998;86:82–6.

    Google Scholar 

  51. Hodsman NBA, Burns J, Blyth A. The morphine sparing effects of diclofenac sodium following abdominal surgery. Anaesthesia. 1987;42:1005–8.

    Article  CAS  PubMed  Google Scholar 

  52. Cohen SE, Subak LL, Brose WG, Halpern J. Analgesia after cesarean delivery: patient evaluations and costs of five opioid technique. Reg Anesth. 1991;16:141–9.

    CAS  PubMed  Google Scholar 

  53. Guay J. The benefits of adding epidural analgesia to general anesthesia: a metaanalysis. J Anesth. 2006;20:335–40.

    Article  PubMed  Google Scholar 

  54. Richman JM, Wu CL. Epidural analgesia for postoperative pain. Anesthesiol Clin North Am. 2005;23:125–40.

    Article  Google Scholar 

  55. Cooper DW, Ryall DM, Desira WR. Extradural fentanyl for postoperative analgesia: predominant spinal or systemic action? Br J Anaesth. 1995;74:184–7.

    Article  CAS  PubMed  Google Scholar 

  56. Correll DJ, Viscusi ER, Grunwald Z, et al. Epidural analgesia compared with intravenous morphine patient controlled analgesia: postoperative outcome measures after mastectomy with immediate TRAM flap breast reconstruction. Reg Anesth Pain Med. 2001;26:444–9.

    CAS  PubMed  Google Scholar 

  57. Block BM, Liu SS, Rowlingson AJ. Efficacy of postoperative epidural analgesia. A meta analysis. JAMA. 2003;290:2455–63.

    Article  CAS  PubMed  Google Scholar 

  58. Wu CL, Cohen SR, Richman JM, et al. Efficacy of postoperative patient controlled and continuous infusion epidural analgesia versus intravenous patient controlled analgesia with opioids. Anesthesiology. 2005;103:1079–88.

    Article  CAS  PubMed  Google Scholar 

  59. Lubenow TR, Tanck EN, Hopkins EM, et al. Comparison of patient—assisted epidural analgesia with continuous-infusion epidural analgesia for postoperative patients. Reg Anesth. 1994;19:206–11.

    CAS  PubMed  Google Scholar 

  60. Nightingale JJ, Knight MV, Higgins B, et al. Randomized, double-blind comparison of patient-controlled epidural infusion vs. nurse administered epidural infusion for postoperative analgesia in patients undergoing colonic resection. Br J Anaesth. 2007;98:380–4.

    Article  CAS  PubMed  Google Scholar 

  61. Liu SS, Allen HW, Olsson GL. Patient-controlled epidural analgesia with bupivacaine and fentanyl on hospital wards: prospective experience with 1,030 surgical patients. Anesthesiology. 1998;88:688–95.

    Article  CAS  PubMed  Google Scholar 

  62. Ellis DJ, Millar WL, Reisner LS. A randomized double blind comparison of epidural versus intravenous fentanyl infusion for analgesia after cesarean section. Anesthesiology. 1990;72:981–6.

    Article  CAS  PubMed  Google Scholar 

  63. Cohen S, Pantuck CB, Amar D, et al. The primary action of epidural fentanyl after cesarean delivery is via a spinal mechanism. Anesth Analg. 2002;94:674–9.

    Article  CAS  PubMed  Google Scholar 

  64. Stirparo S, Laudani A, Haiberger E, et al. Postoperative analgesia after cesarean section: a comparison between programmed intermittent epidural bolus (PIEB) versus continuous epidural infusion (CEI). Reg Anesth Pain Med. 2011;36:E1–E27.

    Article  Google Scholar 

  65. Mc Donnell JG, Curley G, Carney J, et al. The analgesic efficacy of transversus abdominis plane block after cesarean section. Anesth Analg. 2008;106:186–91.

    Article  CAS  Google Scholar 

  66. Barrington MJ, Ivanusic JJ, Rozen WM, Hebbard P. Spread of injectate after ultrasound-guided subcostal transversus abdominis plane block: a cadaveric study. Anaesthesia. 2009;64:745–50.

    Article  CAS  PubMed  Google Scholar 

  67. Bamigboye AA, Hofmeyr GJ. Local anesthetic wound infiltration and abdominal nerves block during cesarean section for postoperative pain relief. Cochrane Database Syst Rev. 2009;3:CD006954.

    Google Scholar 

  68. McMorriw RC, Mhuircheartaigh RJ, Ahmed KA, et al. Comparison of transversus abdominis plane blocks vs. spinal morphine for pain relief after caesarean section. Br J Anaesth. 2011;106:706–12.

    Article  Google Scholar 

  69. Belavy D, Cowlishaw PJ, Howes M, et al. Ultrasound guided transverse abdominis plane block for analgesia after caesarean delivery. Br J Anaesth. 2009;103:726–30.

    Article  CAS  PubMed  Google Scholar 

  70. Siddiqui MR, Sajid MS, Uncles DR, Baig MK. A meta-analysis on the clinical effectiveness of transverse abdominis plane block. J Clin Anesth. 2011;23:7–14.

    Article  PubMed  Google Scholar 

  71. Kramer MS. “Breast is best”: the evidence. Early Hum Dev. 2010;86:729–32.

    Article  PubMed  Google Scholar 

  72. Section B, et al. Breastfeeding and the use of human milk. Pediatrics. 2012;129:e827–41.

    Article  Google Scholar 

  73. Bennett PN. Drugs and human lactation. 2nd ed. Amsterdam: Elsevier; 1996.

    Google Scholar 

  74. Bar-Oz B, Bulkowstein M, et al. Use of antibiotic and analgesic drugs during lactation. Drug Saf. 2003;26:925–35.

    Article  CAS  PubMed  Google Scholar 

  75. Drugs and lactation database (LactMed). U.S. National Library of Medicine, TOXNET Toxicology Data Network.

    Google Scholar 

  76. Wittels C, Scott DT, Sinatra RS. Exogenous opioids in human breast milk and acute neonatal neurobehaviour: a preliminary study. Anesthesiology. 1990;73:864–9.

    Article  CAS  PubMed  Google Scholar 

  77. Feilberg VL, Rosemborg D, Broen CC, et al. Excretion of morphine in human breast milk. Acta Anaesthesiol Scand. 1989;33:426–8.

    Article  CAS  PubMed  Google Scholar 

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  1. Department of Anesthesiology, Città di Roma Hospital, Via Maidalchini 20, Rome, 00152, Italy

    Michela Camorcia

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  1. Michela Camorcia
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Correspondence to Michela Camorcia .

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  1. Dept of Anesthesiolgy, Città di Roma Hospital, Rome, Italy

    Giorgio Capogna

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Camorcia, M. (2017). Postoperative Analgesia. In: Capogna, G. (eds) Anesthesia for Cesarean Section. Springer, Cham. https://doi.org/10.1007/978-3-319-42053-0_11

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