Carvalho Brendan, Butwick Alexander J
Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA.
Best Pract Res Clin Anaesthesiol. 2017 Mar;31(1):69-79. doi: 10.1016/j.bpa.2017.01.003. Epub 2017 Jan 12.
Effective pain management should be a key priority in women undergoing cesarean delivery. Suboptimal perioperative pain management is associated with chronic pain, greater opioid use, delayed functional recovery, impaired maternal-fetal bonding, and increased postpartum depression. Severe acute postoperative pain is also strongly associated with persistent pain after cesarean delivery. Multimodal analgesia is the core principle for cesarean delivery pain management. The use of neuraxial morphine and opioid-sparing adjuncts such as scheduled nonsteroidal anti-inflammatory medications and acetaminophen is recommended for all women undergoing cesarean delivery with neuraxial anesthesia unless contraindicated. Additional analgesic and opioid-sparing options such as wound instillation of local anesthetics, transversus abdominis plane blocks, dexamethasone, gabapentin, and ketamine may be used as appropriate in women at risk of severe postoperative pain or in women whose postoperative pain is not well controlled despite standard analgesic regimes.
有效的疼痛管理应是剖宫产女性的关键优先事项。围手术期疼痛管理不佳与慢性疼痛、更多阿片类药物使用、功能恢复延迟、母婴情感联结受损以及产后抑郁增加有关。严重的急性术后疼痛也与剖宫产术后持续疼痛密切相关。多模式镇痛是剖宫产疼痛管理的核心原则。对于所有接受椎管内麻醉剖宫产的女性，除非有禁忌证，建议使用椎管内吗啡以及阿片类药物节省辅助药物，如定期使用的非甾体类抗炎药和对乙酰氨基酚。对于有严重术后疼痛风险的女性或尽管采用标准镇痛方案但术后疼痛仍控制不佳的女性，可酌情使用其他镇痛和阿片类药物节省选择，如伤口局部麻醉药灌注、腹横肌平面阻滞、地塞米松、加巴喷丁和氯胺酮。
