Perioperative Pain Control for Patients Undergoing Cesarean Delivery

Abstract

opioid-induced hyperalgesia, indicating that patients who receive more opioids intraoperatively become sensitized and thus require more opioids postoperatively.1 These concerns also translate into the peripartum period, especially for patients requiring cesarean deliveries. In 2019, Peahl and colleagues2 reviewed rates of new persistent opioid use in recently delivered patients and found that 75% of patients who underwent cesarean delivery were discharged with an opioid prescription. Of these women, 1% to 2% became persistent users. When compared with the nationwide cesarean delivery rate, that is an astonishing number of new persistent opioid users. Obstetricians have a responsibility to manage pain effectively, while also working to decrease the risk of patients becoming persistent opioid users. This article presents options to support a multimodal approach to peripartum and perioperative pain management for patients undergoing cesarean delivery. It is the physician’s role to evaluate each patient and personalize their pain control regimen, so patients may effectively meet postoperative milestones, care for their newborns, be discharged home from the As physicians and surgeons, obstetricians are acutely aware of the nationwide opioid crisis and the importance of decreasing opioid use both inside and outside of the hospital setting. In one review of perioperative use, it was found that 6% to 10% of patients who underwent either minor or major surgery, not specific to obstetrics and gynecology procedures, were still using opioids 1 year after their procedure.1 This same review noted that opioid dosing during the operative procedure was positively correlated with the postoperative opioid requirement for analgesia. This is thought to be due to acute tolerance secondary to Perioperative Pain Control for Patients Undergoing Cesarean Delivery