The review of this procedure will take place in 2019 and will be published by end of 2021
Knowledge Key:
Arguments against Arguments againste
Arguments for Arguments for
Prospect Recommendation Prospect Recommendation
Clinical Practice Clinical Practice
Transferable Evidence Transferable Evidence
Procedure Specific Evidence Procedure Specific Evidence

Overall PROSPECT Recommendations

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Algorithm for the management of postoperative pain elective C-Section

Overall Recommendations: Pain Management for Elective Caesarean Section Surgery

Pre-operative 

Oral gabapentin

Pre-/intra-operative anaesthetic technique

CSEA or SpA*

Intra-operative, post-delivery

IV paracetamol + IV NSAID #

Wound infiltration with LA or TAP blocks or iliohypogastric/ilioinguinal blocks

Surgical technique

Transverse incision†

Non-closure of peritoneum

Postoperative

Oral paracetamol + oral NSAID + systemic opioid as rescue

Continuous wound infusion with LA

* IT morphine/epidural opioids are recommended, but alternative analgesic techniques such as wound infiltration with LA, TAP block, iliohypogastric and ilioinguinal blocks should be considered to avoid the potential opioid-related side effects of neuraxial opioids

# IV paracetamol and IV NSAID may not be necessary if neuraxial opioids are used

† Amongst transverse incisions, the Joel-Cohen incision and similar modifications are superior to the Pfannenstiel incision for outcomes related to postoperative pain