Adjuvant therapies for postoperative pain management in cesarean section: A comprehensive review of clinical evidence

Abstract

Background

Cesarean section is among the most commonly performed surgical procedures worldwide, and effective postoperative pain management is essential for promoting early ambulation, breastfeeding, maternal–infant bonding, and overall recovery. Although opioids remain effective for post-cesarean analgesia, their use is associated with maternal and neonatal adverse effects, driving increasing interest in opioid-sparing multimodal analgesic strategies incorporating adjuvant therapies.

Main body

This narrative review synthesizes and critically evaluates the clinical evidence supporting pharmacological and non-pharmacological adjuvant therapies for postoperative pain management following cesarean section. Emphasis is placed on agents that target complementary pain pathways, including peripheral inflammation, oxidative stress, and central sensitization. Pharmacological adjuvants such as non-steroidal anti-inflammatory drugs, α2-adrenergic agonists, neuromodulators, antioxidants, and emerging immunomodulatory agents are discussed with respect to their mechanisms of action, analgesic efficacy, opioid-sparing potential, and safety profiles in lactating mothers. Non-pharmacological interventions and multimodal combination strategies within enhanced recovery after cesarean section protocols are also reviewed. Emerging evidence supporting novel agents, including endogenous and nutraceutical-based therapies such as lactoferrin, is highlighted.

Conclusion

Multimodal analgesia incorporating evidence-based adjuvant therapies represents an effective and patient-centered approach to post-cesarean pain management, enabling improved analgesia while minimizing opioid exposure. Selection of adjuvants should be guided by clinical efficacy, safety during lactation, and impact on functional recovery. Further high-quality randomized trials are needed to establish standardized protocols and to clarify the role of emerging adjuvant agents in optimizing post-cesarean analgesic outcomes.