Indian Journal of Anaesthesia  
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REVIEW ARTICLE
Year : 2017  |  Volume : 61  |  Issue : 3  |  Page : 200-214

Post-caesarean analgesia: What is new?


1 Department of Anaesthesiology, Rajiv Gandhi Super Speciality Hospital, New Delhi, India
2 Department of Anaesthesiology and Intensive Care, Maulana Azad Medical College and Associated Hospitals, New Delhi, India

Correspondence Address:
Sukhyanti Kerai
B 3/59, Upper Ground Floor, Paschim Vihar, New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ija.IJA_313_16

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Adequate post-operative analgesia after caesarean section (CS) is vital as it impacts the distinct surgical recovery requirements of the parturient. Although newer analgesic modalities and drugs for post-caesarean analgesia have been introduced over the recent years, review of the literature suggests suggests that we are far from achieving the goals of optimum post-operative analgesia. We conducted a systematic review of recent advances in modalities for post-caesarean analgesia. After systematic search and quality assessment of studies, we included a total of 51 randomised controlled trials that evaluated the role of opioids, transversus abdominis plane (TAP) block, wound infiltration/infusion, ketamine, gabapentin and ilioinguinal-iliohypogastric nerve block (II-IH NB) for post-caesarean analgesia. Administration of opioids still remains the gold standard for post-operative analgesia, but the associated troublesome side effects have led to the mandatory incorporation of non-opioid analgesics in post-CS analgesia regime. Among the non-opioid techniques, TAP block is the most investigated modality of the last decade. The analgesic efficacy of TAP block as a part of multimodal analgesia is established in post-CS cases where intrathecal morphine is not employed and in CS under general anaesthesia. Among non-steroidal anti-inflammatory drugs, COX-I inhibitors and intravenous paracetamol are found to be useful in post-operative analgesic regimen. The perioperative use of ketamine is found useful only in CS done under spinal anaesthesia; no benefit is seen where general anaesthesia is employed. Wound infiltration with local anaesthetics, systemic gabapentin and II-IH NB need further trials to assess their efficacy.


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