In Obstetrics and Gynecology

Abstract

Delivery by CS is becoming more frequent and is one of the most common major operative procedures performed worldwide. Childbirth is an emotional experience for a woman and her family. The mother needs to bond with the new baby as early as possible and initiate early breastfeeding, which helps to contract the uterus and accelerates the process of uterine involution in the postpartum period. Any form of intervention that leads to improvement in pain relief can positively impact on early breastfeeding. Prompt and adequate postoperative pain relief is therefore an important component of caesarean delivery. Pain causes increase in the sympathetic response of body with subsequent rise in heart rate, cardiac work and oxygen consumption. Prolong pain can reduce physical activity and leads to venous stasis and an increase risk of deep vein thrombosis and subsequent pulmonary embolism. In addition there can be wide spread effects on gut and urinary tract motility which may lead to post operative ileus, nausea, vomiting and urinary retention. These problems are unpleasant for the patients and may result in prolong hospital stay. Patients show variable threshold for pain, however, 75% of surgical patients have severe postoperative incisional pain. Pain relief may cause good psychological and physical effects in patients, which could lead to better recovery from surgical procedures and early mobilization of patients to prevent complications like deep vein thrombosis etc. Postoperative pain after CS is usually managed with opioids. These agents generally exert their analgesic effects through μ-receptors in the CNS, although there is evidence that opioids may also act at peripheral opioid receptors. Realistically, the analgesic efficacy of opioids is typically limited by the development of tolerance or opioid related side effects such as nausea, vomiting, sedation, or respiratory depression. Local anesthetics cause reversible blockade of impulse propagation along the nerve fibers by preventing the influx of Na+ through the cell membrane of the fibers. Several studies have reported on use of pre-emptive local anesthetics to relieve postoperative pain, with results ranging from being beneficial to conferring no benefit. The local anesthetic may be administered by pre- or post incisional abdominal nerve block “local anesthetic injected to block the nerves before cutting the skin at the beginning of the operation, or after closing the skin at the end” or pre- or post-incisional abdominal wound infiltration. It may also be administered by continuous wound irrigation.