A Practical Approach to Obstetric Anesthesia by Brenda A. Bucklin & Curtis L. Baysinger & David Gambling

Author:Brenda A. Bucklin & Curtis L. Baysinger & David Gambling [Bucklin, Brenda A.]
Language: eng
Format: epub, pdf
ISBN: 9781469882864
Publisher: LWW
Published: 2016-01-19T23:00:00+00:00

Postpartum Issues

Postcesarean Analgesia

Richard N.Wissler

I.

Introduction

II.

Multimodal therapy

A. Goals

B. Components of multimodal therapy

III.

Medications: oral, systemic, neuraxial, and regional administration

A. Opioids

B. Local anesthetics

C. Nonsteroidal anti-inflammatory drugs

D. Acetaminophen

E. Other medications

F. Medications in breast milk

IV.

Summary

KEYPOINTS

1.The use of multimodal analgesia and differing routes of administration will increase overall postcesarean delivery (post-CD) analgesia and reduce the incidence of unwanted side effects.

2.Opioids are the mainstay of post-CD analgesia. Intravenous patient-controlled analgesia (PCA) opioid administration provides superior pain relief compared to intermittent caregiver administration and may have analgesic effectiveness comparable to neuraxial opioid administration.

3.Neuraxial opioids are the gold standard in providing post-CD analgesia by decreasing overall opioid consumption, improving ambulation, allowing earlier return of bowel function, and improving reductions in breast milk levels of opioids compared to systemically administered opioids.

4.Neuraxial opioids are associated with nausea, vomiting, urinary retention, respiratory depression, and pruritus.

5.Continuous wound infiltration with local anesthetic using catheter techniques may offer significant post-CD analgesia. The use of transversus abdominis blockade does not offer significant analgesic advantage when added to neuraxial opioid administration.

6.Nonsteroidal anti-inflammatory drugs, when administered orally or intravenously and when added to local anesthetics used in neuraxial blockade, are useful analgesic adjuncts to opioids. Acetaminophen may offer significant analgesia and is safe for mother and child.

7.Predicting the effects of maternally administered medications that appear in breast milk is complex. Consulting the published guidelines written by professional organizations is recommended

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