Postcesarean analgesia

A commitment to postoperative analgesia has been mandated in the present health care environment. Pain assessment as the fifth vital sign provides the opportunity for us to identify and treat a symptom that has for years been undermanaged. Intrapartum analgesia has always been an important part of the practice of obstetrical anesthesiology. The cesarean delivery, at 38% of all deliveries, is now the most common surgical procedure in the United States, and thus we must address postpartum/postoperative analgesia as part of our obstetrical anesthesia practice. The goal of intrapartum analgesia has always been to provide safe and efficacious analgesia with minimal effects on the mother, fetus, or course of labor. Postcesarean analgesia must also be safe and efficacious, with minimal effect on the mother's ability to bond with her newborn. The physiologic perturbations associated with pregnancy and the surgical stress and physiologic changes that occur with intra-abdominal surgery affect maternal well-being and postoperative outcome. Pain therapy must take into account all of these variables. Nikolajsen et al has suggested that patients with recall of severe postoperative pain are more likely to experience chronic pain following cesarean delivery. More effective analgesia would thus minimize the occurrence of chronic pain complaints. Women recovering from cesarean section desire to ambulate early and care for their infants. However, because of their wish to bond with their babies, many mothers avoid analgesics that may cause sedation and as a result have a level of pain that impairs mobility.