Post-cesarean delivery pain management

Abstract

Cesarean delivery is one of the most common surgical procedures worldwide and is associated with moderate-to-severe postoperative pain. This review summarizes current evidence and guidelines for optimizing postoperative pain management while minimizing opioid-related side effects. Neuraxial long-acting opioids remain the gold standard but are limited by side effects such as pruritus, nausea, and urinary retention. Field blocks, including quadratus lumborum and erector spinae blocks, offer promising alternatives, though no single technique has demonstrated clear superiority over the other. Epidural analgesia provides effective pain control; however, its impact on early recovery limits its use in many settings. Routine administration of paracetamol and nonsteroidal anti-inflammatory drugs forms the foundation of multimodal analgesia and is universally recommended for being a simple intervention with minimal side effects. A single intraoperative dose of dexamethasone enhances analgesia and reduces opioid consumption without increasing risk of wound complications. Adjuvant analgesic techniques such as transcutaneous electrical nerve stimulation show potential benefits; however, more high-quality evidence is required before its implementation in routine practice. Finally, this review highlights gaps in current knowledge and emphasizes the need for standardized protocols and high-quality comparative studies to refine analgesic strategies for cesarean delivery.

Keywords: Analgesia; cesarean delivery; dexamethasone; electric stimulation therapy; neuraxial opioids; nonsteroidal anti-inflammatory drugs; paracetamol; regional anesthesia.